NPIMap

Organization Active NPI

Dr. Justin Moody, PLLC

  • General Practice Dentistry
  • Tacoma, WA
National Provider Identifier
1194577171
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DR. JUSTIN MOODY, PLLC
Practice address
2501 N Pearl St
Tacoma, WA 98406-2540
Phone
(253) 752-6349
NPI assigned
Apr 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Craig Smith, DDS
Title
Managing Dentist
Phone
(253) 752-6349

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2501 N Pearl St
Tacoma, WA 98406-2540

Mailing address

2501 N Pearl St
Tacoma, WA 98406-2540
Phone (253) 752-6349

Other names 1

  • Advanced Dental Implant Center - Tacoma Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1194577171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 N PEARL ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984062540",
            "telephone_number": "253-752-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 N PEARL ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984062540",
            "telephone_number": "253-752-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JUSTIN MOODY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "MANAGING DENTIST",
        "authorized_official_telephone_number": "253-752-6349",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Implant Center - Tacoma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.