Organization
MOODY HANAHAN DENTISTRY LLC
Active
Other names
Humbert Road Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SARA HANAHAN DMD (OWNER)
(618) 465-8100
Entity
Organization
Contact information
Practice address
4119 HUMBERT RD, ALTON, IL 62002-7116
(314) 477-1777
(618) 462-3530
Mailing address
4119 HUMBERT RD, ALTON, IL 62002-7116
(314) 477-1777
(618) 462-3530
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700984317
STACY MOODY - INDIVIDUAL NPI
—
01
—
1740703149
SARA HANAHAN - INDIVIDUAL NPI
—
Enumeration date
03/05/2020
Last updated
03/06/2020
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