Individual
EVAN PAUL MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
2080 CHILD ST ORAL & MAXILLOFACIAL SURGERY DEPARTMENT, JACKSONVILLE, FL 32214-2640
(904) 542-7540
(904) 542-7543
Mailing address
2315 MILLER OAKS DR N, JACKSONVILLE, FL 32217-3507
(913) 748-9988
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN25752
FL
Other
Enumeration date
02/16/2010
Last updated
09/26/2023
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