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Organization
MOODY HANAHAN DENTISTRY LLC
Active
Organization
MOODY HANAHAN DENTISTRY LLC
Active
Other names
Humbert Road Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SARA HANAHAN DMD (OWNER)
(618) 465-8100
Entity
Organization
Contact information
Practice address
4119 HUMBERT RD, ALTON, IL 62002-7116
(314) 477-1777
(618) 462-3530
Mailing address
4119 HUMBERT RD, ALTON, IL 62002-7116
(314) 477-1777
(618) 462-3530
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700984317
STACY MOODY - INDIVIDUAL NPI
—
01
—
1740703149
SARA HANAHAN - INDIVIDUAL NPI
—
Enumeration date
03/05/2020
Last updated
03/06/2020
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