Provider Demographics
NPI:1770698342
Name:MOODY, CHRISTIE L (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:L
Last Name:MOODY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 NORTH PARK BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9265
Mailing Address - Country:US
Mailing Address - Phone:843-553-7227
Mailing Address - Fax:843-824-8257
Practice Address - Street 1:8730 NORTH PARK BLVD
Practice Address - Street 2:STE E
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9265
Practice Address - Country:US
Practice Address - Phone:843-553-7227
Practice Address - Fax:843-824-8257
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist