| Moody Dental Llc | |
|
13955 Morse St Cedar Lake IN 46303-9639 | |
| (219) 374-5591 | |
| (219) 374-5592 |
| Full Name | Moody Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 13955 Morse St, Cedar Lake, Indiana |
| Authorized Official Name and Position | Moody Wasif (DENTIST/OWNER) |
| Authorized Official Contact | 2193226892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moody Dental Llc 13955 Morse St Cedar Lake IN 46303-9639 Ph: (219) 374-5591 | Moody Dental Llc 13955 Morse St Cedar Lake IN 46303-9639 Ph: (219) 374-5591 |
| NPI Number | 1396110508 |
|---|---|
| Provider Enumeration Date | 12/14/2015 |
| Last Update Date | 12/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396110508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12011396A (Indiana) | Primary |
Detailed Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13963 Morse St, Cedar Lake, IN 46303 Phone: 219-374-2400 | |
Cedar Lake Dental Center, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13955 Morse St, Cedar Lake, IN 46303 Phone: 219-374-5591 Fax: 219-662-2573 |