Edward Morris Moody III, DDS
Individual provider Active NPI General Practice Dentistry · Rayne, LA
NPI 1669920591 · NPPES record last updated Sep 20, 2016
Key facts
- NPI
- 1669920591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5490 (LA)
- Practice address
- 404 E Texas Ave
Rayne, LA 70578-6435 - Phone
- (337) 334-2967
- Fax
- (337) 334-2967
- NPI assigned
- Sep 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5490 | LA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5490 | LA | Yes |
Addresses
Primary practice location
404 E Texas Ave
Rayne, LA 70578-6435
Mailing address
404 E Texas Ave
Rayne, LA 70578-6435
Phone (337) 334-2967
Other providers in Rayne, LA
- Chassidy Martin
- Raphael J Meche
- Meche'S Family Drugs, Inc.
- Kourtney Lynn Menard
- Deborah Lebeouf Mire
- Edward Morris Moody II
- Mouton Pharmacy Inc
- Rachel E Mouton
- Diane Navarre
- Verna Olinger
All providers in Rayne, LA · General Practice Dentistry in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.