Individual
DR. JERRY WAYNE MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
501 TYEE DR SW, TUMWATER, WA 98512-7313
(360) 352-5100
(360) 705-1274
Mailing address
501 TYEE DR SW, TUMWATER, WA 98512-7313
(360) 352-5100
(360) 705-1274
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00006219
WA
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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