Edwardsville Family Dentist
NPI #1063899417 in Edwardsville, Illinois
Provider Information
- NPI Number
- 1063899417
- Entity Type
- Organization
- Organization Name
- Edwardsville Family Dentist
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- May 5, 2015
- Last Updated
- Jul 24, 2023
Practice Location
- Address
- 1811 LINDENWOOD AVE
- City
- Edwardsville
- State
- Illinois
- ZIP Code
- 62025-2580
- Phone
- (618) 659-0456
Authorized Official
- Name
- DR. BEAU G MOODY, DMD
- Title
- DENTIST/OWNER
- Phone
- (618) 659-0456
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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