Individual
MR. ROBERT MICHAEL MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
302 W 3RD ST, EUREKA, KS 67045-1404
(620) 583-7489
(620) 583-7489
Mailing address
302 W 3RD ST, EUREKA, KS 67045-1404
(620) 583-7489
(620) 583-7489
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5279
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092550-A
—
KS
01
—
BCBS
05983
KS
Enumeration date
08/11/2005
Last updated
08/09/2007
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