Stacy Renae Moody DMD

NPI 1700984317 - Dentist - 1223G0001X

NPI Details
NPI 1700984317
Gender Female
Enumeration Date 09/20/2006
Last Updated 10/30/2013
Entity Type Individual
Active Over 10 years ago
Practice Location
3120 MARYVILLE RD
GRANITE CITY IL, 62040-5189, US
Phone (618) 797-9940
Fax
Business Location
3120 MARYVILLE RD
GRANITE CITY IL, 62040-5189, US
Phone (618) 797-9940
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Illinois
License Number 019026581
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According to our database, Stacy Renae Moody DMD NPI is 1700984317, taxonomy code is 1223G0001X and license number is 019026581, license state is located at Illinois. Stacy Renae Moody DMD physically located at 3120 Maryville Rd, Granite City IL, 62040-5189. NPI Number Stacy Renae Moody DMD has the Individual type.

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1700984317 NPI number is provided on an as is basis without warranty of any kind. 1700984317 is maintained by the National Plan & Provider Enumeration System. The contents of Stacy Renae Moody DMD are for informational purposes only.