Organization
MOODY DENTAL IMPLANT CENTERS LLC
Active
Other names
The Dental Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN D MOODY DDS (OWNER)
(605) 716-5622
Entity
Organization
Contact information
Practice address
705 COLUMBUS ST, RAPID CITY, SD 57701-3623
(605) 716-5622
(605) 791-2982
Mailing address
705 COLUMBUS ST, RAPID CITY, SD 57701-3623
(605) 716-5622
(605) 791-2982
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
M881
SD
Other
Enumeration date
11/01/2011
Last updated
09/22/2016
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