Individual
JOHN A MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4040 MORSAY DR, ROCKFORD, IL 61107-4851
(815) 399-0866
(815) 399-0895
Mailing address
10121 BRIARWOOD CT, BELVIDERE, IL 61008-8581
(815) 871-9545
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19024011
IL
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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