Provider Demographics
NPI:1679349088
Name:MOODY, DWIGHT VINCENT
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:VINCENT
Last Name:MOODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 LILLIAN
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1635
Mailing Address - Country:US
Mailing Address - Phone:313-327-7167
Mailing Address - Fax:
Practice Address - Street 1:8342 LILLIAN
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1635
Practice Address - Country:US
Practice Address - Phone:313-327-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care