Provider Demographics
NPI:1760551378
Name:MOODY, MAXWELL III (DMMD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:MOODY
Suffix:III
Gender:M
Credentials:DMMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E HARGROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5032
Mailing Address - Country:US
Mailing Address - Phone:205-349-3150
Mailing Address - Fax:205-349-3150
Practice Address - Street 1:400 E HARGROVE RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5032
Practice Address - Country:US
Practice Address - Phone:205-349-3150
Practice Address - Fax:205-349-3150
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist