Individual
DR. JUSTIN D. MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
705 1ST ST, BOX 488, CRAWFORD, NE 69339-1186
(308) 665-2025
(308) 665-1506
Mailing address
705 1ST ST, PO BOX 488, CRAWFORD, NE 69339-1186
(308) 665-2025
(308) 665-1506
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6124
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026079200
—
NE
05
—
10026079300
—
NE
05
—
10026079400
—
NE
Enumeration date
09/15/2010
Last updated
11/01/2011
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