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Organization
MARKET STREET FAMILY DENTIST, PC
Active
Organization
MARKET STREET FAMILY DENTIST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEAU MOODY DMD (PRESIDENT)
(618) 667-6101
Entity
Organization
Contact information
Practice address
212 E MARKET ST, TROY, IL 62294-1512
(618) 667-6101
Mailing address
212 E MARKET ST, TROY, IL 62294-1512
(618) 667-6101
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/02/2020
Last updated
07/24/2023
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