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NPI Code Detail

MEDICARE: DR. JUSTIN MOODY, PLLC

MEDICARE: DR. JUSTIN MOODY, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1194577171
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. JUSTIN MOODY, PLLC
Provider Business Mailing Address
First Line : 2501 N PEARL ST
Second Line :
City : TACOMA
State : WA
Zip : 98406-2540
Country : US
Telephone Number : 253-752-6349
Fax Number :
Provider Business Practice Location Address
First Line : 2501 N PEARL ST
Second Line :
City : TACOMA
State : WA
Zip : 98406-2540
Country : US
Telephone Number : 253-752-6349
Fax Number :
Authorized Official
Title or Position : MANAGING DENTIST
Name : CRAIG SMITH
Credential : DDS
Telephone Number : 253-752-6349
Provider Enumeration Date : 04/03/2024
Last Update Date : 07/30/2024

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