Organization
VISTA RIDGE DENTAL ARTS STUDIO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY HERRON MOODY DDS (DENTIST/SOLE MBR)
(804) 979-1800
Entity
Organization
Contact information
Practice address
108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
(423) 979-1800
(423) 979-1802
Mailing address
108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
(423) 979-1800
(423) 979-1802
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10324
TN
Other
Enumeration date
12/27/2017
Last updated
12/27/2017
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