MOODY HANAHAN DENTISTRY LLC NPI 1528693926

NPI Information

NPI: 1528693926
Provider Name: MOODY HANAHAN DENTISTRY LLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
4119 HUMBERT RD
ALTON, IL
ZIP 62002
Phone: (314) 477-1777
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MOODY HANAHAN DENTISTRY LLC is a dental clinic center in Alton, IL. MOODY HANAHAN DENTISTRY LLC NPI is 1528693926. The provider is registered as an organization entity type.

The provider's business location address is:

4119 HUMBERT RD
ALTON, IL
ZIP 62002-116
Phone: (314) 477-1777
Fax: (618) 462-3530

The provider's authorized official is Sara Hanahan .
The authorized official title is Owner and has the following contact phone number (618) 465-8100.

The enumeration date for this NPI number is 3/5/2020 and was last updated on 3/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1740703149	OTHER		SARA HANAHAN - INDIVIDUAL NPI
2	1700984317	OTHER		STACY MOODY - INDIVIDUAL NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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