Healthcare Provider Details

I. General information

NPI: 1841119260
Provider Name (Legal Business Name): MCKINNA MOODY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 DAVIS ST
ASHEBORO NC
27203-5469
US

IV. Provider business mailing address

PO BOX 306
MAIDEN NC
28650-0306
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: