=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700738473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.D. MOODY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2026
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 184TH ST SW STE 118
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98037-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-749-7359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 184TH ST SW STE 118
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98037-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-749-7359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUSTIN MOODY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 425-749-7354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------