Beau G. Moody, DMD

Dentist · Edwardsville, IL

Individual Active NPI

NPI number 1780917823

Practice location

1811 Lindenwood Ave
Edwardsville, IL 62025-2580
Phone
(618) 659-0456

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NPI record

NPI
1780917823
Entity type
Individual (Type 1)
Enumeration date
September 8, 2009
Last updated
June 15, 2021
Certified
June 15, 2021
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X 019.028093 IL

Other practice locations (1)

  • 212 E Market St, Troy, IL 62294-1512 · (618) 667-6101

About Dr. Moody

Beau G. Moody, DMD is a healthcare provider registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 1811 Lindenwood Ave, Edwardsville, IL 62025-2580. The NPI number 1780917823 was assigned on September 8, 2009 and the record was last updated on June 15, 2021.

Dr. Moody lists a license in the registry: #019.028093 (IL) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Beau G. Moody, DMD?

The NPI number is 1780917823.

What is the phone number of Dr. Moody?

The phone number listed for the practice location is (618) 659-0456.

Where is Dr. Moody located?

1811 Lindenwood Ave, Edwardsville, IL 62025-2580.

What is the taxonomy code for Dr. Moody?

The primary taxonomy code is 122300000X – Dentist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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