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Individual

DR. BEAU G MOODY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1811 LINDENWOOD AVE, EDWARDSVILLE, IL 62025-2580
(618) 659-0456
Mailing address
1811 LINDENWOOD AVE, EDWARDSVILLE, IL 62025-2580
(618) 659-0456

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.028093
IL

Other

Enumeration date
09/08/2009
Last updated
06/15/2021
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