Provider Demographics
NPI:1891110524
Name:MOODY, DANA R (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:R
Last Name:MOODY
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ELURIA ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2773
Mailing Address - Country:US
Mailing Address - Phone:541-786-2843
Mailing Address - Fax:
Practice Address - Street 1:155 ELURIA ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2773
Practice Address - Country:US
Practice Address - Phone:541-786-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4010124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist