Healthcare Provider Details

I. General information

NPI: 1992112528
Provider Name (Legal Business Name): GREGORY MOODY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 COPPER CREEK DR
PLEASANT HILL IA
50327-7000
US

IV. Provider business mailing address

1286 COPPER CREEK DR
PLEASANT HILL IA
50327-7000
US

V. Phone/Fax

Practice location:
  • Phone: 515-263-1414
  • Fax:
Mailing address:
  • Phone: 515-263-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10475
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: