Individual
FORREST MOUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 E 10TH ST, DANVILLE, AR 72833-0878
(479) 495-2115
(479) 495-2267
Mailing address
PO BOX 878, DANVILLE, AR 72833-0878
(479) 495-2115
(479) 495-2267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2030
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106597608
—
AR
Enumeration date
03/11/2014
Last updated
03/11/2014
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