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Moody Hanahan Dentistry Llc
Dental Clinic/Center in Alton, Illinois
NPI 1528693926

Moody Hanahan Dentistry Llc is a Dental Clinic/Center based in Alton, IL and is specialized in Dental. Moody Hanahan Dentistry Llc practices in Alton, IL. The NPI Number for Moody Hanahan Dentistry Llc is 1528693926 and holds a License No. (Illinois).

The current practice location address for Moody Hanahan Dentistry Llc is 4119 Humbert Rd, Alton, IL and can be reached out via phone at 314-477-1777 and via fax at 618-462-3530.

Location: 4119 Humbert Rd, Alton, IL, 62002-7116
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1528693926
Provider Name
Moody Hanahan Dentistry Llc
Credential
Provider Entity Type
Organization
Address
4119 Humbert Rd, Alton, IL, 62002-7116
Phone Number
314-477-1777
Fax Number
618-462-3530
Provider Enumeration Date
03/05/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1740703149 01 SARA HANAHAN - INDIVIDUAL NPI
1700984317 01 STACY MOODY - INDIVIDUAL NPI
institution
Provider Business Practice Location Address Details
Address
4119 Humbert Rd
City
Alton
State
Illinois
Zip
62002-7116
Phone Number
314-477-1777
Fax Number
618-462-3530
person
Provider Business Mailing Address Details
Address
4119 Humbert Rd
City
Alton
State
Illinois
Zip
62002-7116
Phone Number
314-477-1777
Fax Number
618-462-3530
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
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Definition
Definition to come...
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