| Moody Hanahan Dentistry Llc | |
|
4119 Humbert Rd Alton IL 62002-7116 | |
| (314) 477-1777 | |
| (618) 462-3530 |
| Full Name | Moody Hanahan Dentistry Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4119 Humbert Rd, Alton, Illinois |
| Authorized Official Name and Position | Sara Hanahan (OWNER) |
| Authorized Official Contact | 6184658100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moody Hanahan Dentistry Llc 4119 Humbert Rd Alton IL 62002-7116 Ph: (314) 477-1777 | Moody Hanahan Dentistry Llc 4119 Humbert Rd Alton IL 62002-7116 Ph: (314) 477-1777 |
| NPI Number | 1528693926 |
|---|---|
| Provider Enumeration Date | 03/05/2020 |
| Last Update Date | 03/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528693926 | NPI | - | NPPES |
| 1740703149 | Other | SARA HANAHAN - INDIVIDUAL NPI | |
| 1700984317 | Other | STACY MOODY - INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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