Organization
MOODY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOODY WASIF D.M.D (DENTIST/OWNER)
(219) 322-6892
Entity
Organization
Contact information
Practice address
13955 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-5591
(219) 374-5592
Mailing address
13955 MORSE ST, CEDAR LAKE, IN 46303-9639
(219) 374-5591
(219) 374-5592
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011396A
IN
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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