Moody, Stacy Renae
Moody, Stacy Renae is an individual health care provider with primary practice located at 3120 Maryville Rd , Granite City IL 62040-5189. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Moody, Stacy Renae can be contacted via phone (618) 797-9940.Contact Information
Primary practice address
3120 Maryville Rd
Granite City IL 62040-5189
Phone: (618) 797-9940
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 019026581 | Illinois |
Profile Details
| NPI number | 1700984317 |
|---|---|
| LBN Legal business name | Moody, Stacy Renae |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Oct 30th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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