NPI: 1902098452 · EL DORADO, KS 67042 · General Practice Dentistry · NPI assigned 08/17/2007
| Authorized Official | MOODY, ROBERT (OWNER/DENTIST) |
| NPI Enumeration Date | 08/17/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 14 | $253.45 |
| 2019 | 14 | $257.04 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 28 | 26 | $510.49 |