Provider Demographics
NPI:1336484351
Name:MOODY, LYNNE (RDH)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1811
Mailing Address - Country:US
Mailing Address - Phone:774-849-0551
Mailing Address - Fax:
Practice Address - Street 1:121 COUNTY ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1811
Practice Address - Country:US
Practice Address - Phone:774-849-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH10503124Q00000X, 125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No125K00000XDental ProvidersAdvanced Practice Dental Therapist