Individual
JUSTIN MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 663-3900
Mailing address
898 E EMERSON AVE, SALT LAKE CITY, UT 84105-2219
(801) 885-8503
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10809874-9922
UT
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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