Moody Dental LLC

NPI #1396110508 in Cedar Lake, Indiana

Provider Information

NPI Number: 1396110508
Entity Type: Organization
Organization Name: Moody Dental LLC
Primary Specialty: Dentist
Enumeration Date: Dec 14, 2015
Last Updated: Dec 14, 2015

Practice Location

Address: 13955 MORSE ST
City: Cedar Lake
State: Indiana
ZIP Code: 46303-9639
Phone: (219) 374-5591

Authorized Official

Name: DR. MOODY WASIF, D.M.D
Title: DENTIST/OWNER
Phone: (219) 322-6892

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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