MEDICARE: MRS. DANA R MOODY RDH, BS

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
1	124Q00000X	Dental Hygienist	H4010	OR

General Provider Information

NPI Number	:	1891110524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA R MOODY RDH, BS

Provider Business Mailing Address
First Line	:	155 ELURIA ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2773
Country	:	US
Telephone Number	:	541-786-2843
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 ELURIA ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2773
Country	:	US
Telephone Number	:	541-786-2843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	03/05/2014

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