Organization
FORREST L MOUDY DDS PA INC
Active
Other names
Forrest L Moudy DDS
Organization subpart
No
Provider details
NPI number
Authorized official
FORREST L MOUDY DDS (PRESIDENT)
(479) 495-2115
Entity
Organization
Contact information
Practice address
105 E 10TH ST, DANVILLE, AR 72833-0878
(479) 495-2115
(479) 495-2267
Mailing address
PO BOX 878, DANVILLE, AR 72833-0878
(479) 495-2115
(479) 495-2267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2030
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58359
BLUE CROSS BLUE SHIELD
AR
01
—
846563
UNITED CONCORDIA
AR
Enumeration date
09/19/2006
Last updated
08/22/2020
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