Beau G Moody, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.028093 Issued in IL

Practice address

1811 Lindenwood Ave
Edwardsville, IL 62025-2580

Phone

(618) 659-0456

NPI assigned

Sep 8, 2009

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edwardsville Family Dentist

  • Dental Clinic/Center
  • Edwardsville, IL
  • NPI 1063899417
  NPD Authorized official
• Market Street Family Dentist, PC

  • Dental Clinic/Center
  • Troy, IL
  • NPI 1750127601
  NPD Authorized official
• Market Street Family Dentist, PC

  • Dental Clinic/Center
  • Troy, IL
  • NPI 1770122194
  NPD Authorized official

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1780917823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 LINDENWOOD AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252580",
            "telephone_number": "618-659-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 LINDENWOOD AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252580",
            "telephone_number": "618-659-0456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 E Market St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "IL",
            "postal_code": "622941512",
            "country_code": "US",
            "telephone_number": "618-667-6101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOODY",
        "first_name": "BEAU",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-08",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.028093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Degen Milton, PT
• Andrea Marie Mohr
• Briana Molleck, BSN, RN
• Montclaire Eye Associates
• Margaret Montibeller, APN, CNP
• Lupana Regina Morales, ATC, LAT
• Kelly Colleen Morgan, RN
• Morning Glory Homecare LLC
• Waliat Adejoke Moronkola
• Domynik Matthew Mowrey

• Dentist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.