| NPI | 1740202852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD HERBERT MOODY President 423-587-1421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS4447) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-08-22 |