Provider Demographics
NPI:1043942535
Name:MOODY, MORGAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:LEE
Last Name:MOODY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4425
Mailing Address - Country:US
Mailing Address - Phone:813-728-3006
Mailing Address - Fax:
Practice Address - Street 1:1430 LONNIE ABBOTT BLVD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1851
Practice Address - Country:US
Practice Address - Phone:580-279-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice