Provider Demographics
NPI:1033216924
Name:MOUDY, BOBBY TOM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:TOM
Last Name:MOUDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WEST YOAKUM
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740
Mailing Address - Country:US
Mailing Address - Phone:573-887-3232
Mailing Address - Fax:
Practice Address - Street 1:135 WEST YOAKUM
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:MO
Practice Address - Zip Code:63740
Practice Address - Country:US
Practice Address - Phone:573-887-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO9356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist