Evan Paul Moody, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN25752 Issued in FL

Practice address

2080 Child St Oral & Maxillofacial Surgery Department
Jacksonville, FL 32214-2640

Phone

(904) 542-7540

Fax

(904) 542-7543

NPI assigned

Feb 16, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1497077523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 MILLER OAKS DR N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322173507",
            "telephone_number": "913-748-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST ORAL & MAXILLOFACIAL SURGERY DEPARTMENT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322142640",
            "telephone_number": "904-542-7540",
            "fax_number": "904-542-7543"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7909 Normandy Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322216640",
            "country_code": "US",
            "telephone_number": "904-786-1309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "EVAN",
        "middle_name": "PAUL",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-16",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN25752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy C Montz, DPT, MS, ATC
• Monument-9a Imaging & Diagnostic Center L L C
• Austin Moody, M.D.
• Braeden Moody
• Dereck Moody
• Hannah Moody
• Hidi Leigh McChesney Moody, APRN
• Kelsey Moody
• Laree Pruitt Moody, RN
• Chelsea Taylor Moon-Tison

• Oral and Maxillofacial Surgery (Dentist) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.