Individual
DR. CAROLYN S MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5693
KY
1223P0221X
Pediatric Dentistry
Primary
5693
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45601101
—
KY
05
—
60056934
—
KY
Enumeration date
12/05/2005
Last updated
01/09/2014
Update your record
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