Organization
R.M. MOODY,DDS/EL DORADO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT M MOODY DDS (OWNER/DENTIST)
(316) 320-3636
Entity
Organization
Contact information
Practice address
122 N TAYLOR ST, EL DORADO, KS 67042-1839
(316) 320-3636
(316) 320-3636
Mailing address
122 N TAYLOR ST, EL DORADO, KS 67042-1839
(316) 320-3636
(316) 320-3636
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092550-B
—
KS
Enumeration date
08/17/2007
Last updated
08/17/2007
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