Provider Demographics
NPI:1265624712
Name:ROBERT M MOODYDDS/ EUREKA
Entity type:Organization
Organization Name:ROBERT M MOODYDDS/ EUREKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-583-7489
Mailing Address - Street 1:302 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:KS
Mailing Address - Zip Code:67045-1404
Mailing Address - Country:US
Mailing Address - Phone:620-583-7489
Mailing Address - Fax:620-583-7489
Practice Address - Street 1:302 W 3RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:KS
Practice Address - Zip Code:67045-1404
Practice Address - Country:US
Practice Address - Phone:620-583-7489
Practice Address - Fax:620-583-7489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT M. MOODY/EL DORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty