MEDICARE: DR. PATRICK O. MORIARTY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6355	KS

General Provider Information

NPI Number	:	1477552370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK O. MORIARTY D.D.S.

Provider Business Mailing Address
First Line	:	2034 E 1550 RD
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66044-9309
Country	:	US
Telephone Number	:	785-841-4703
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 CLINTON PKWY
Second Line	:	SUITE G
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2145
Country	:	US
Telephone Number	:	785-832-2882
Fax Number	:	785-832-1994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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