Healthcare Provider Details

I. General information

NPI: 1306763347
Provider Name (Legal Business Name): ANNABELLA TERRAH MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 SILVERHEEL ST
SHAWNEE KS
66226-5300
US

IV. Provider business mailing address

8008 BROCKWAY ST
LENEXA KS
66220-9610
US

V. Phone/Fax

Practice location:
  • Phone: 913-322-6455
  • Fax:
Mailing address:
  • Phone: 620-687-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62405
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: