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General NPI Number Information
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NPI Number | 1841696184
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Entity Type | Individual
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Provider Name | WILLIAM HEATH MOODY DMD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 393 COUNTY ROAD 554
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City | ATHENS
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State | TN
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Zip | 37303-6420
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Country | US
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Telephone | 423-745-7431
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 STELLATTA CV NW
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City | CLEVELAND
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State | TN
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Zip | 37312-2473
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Country | US
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Telephone | 770-639-3829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9941
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License Number State | TN
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