Healthcare Provider Details

I. General information

NPI: 1033037981
Provider Name (Legal Business Name): ABAGAYLE THOMAS MOODY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

3737 FARNAM ST
OMAHA NE
68131-3123
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6100
  • Fax:
Mailing address:
  • Phone: 620-687-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8217
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: