Provider Demographics
NPI:1598008070
Name:MOODY, KRISTI HALLOWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:HALLOWELL
Last Name:MOODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1928
Mailing Address - Country:US
Mailing Address - Phone:972-377-7800
Mailing Address - Fax:
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1928
Practice Address - Country:US
Practice Address - Phone:972-377-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist