MEDICARE: DR. MARTHA P. MORELAND 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	07551	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41887	OTHER	IA	DELTA DENTAL -DELTA USA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	41887	OTHER	IA	WELLMARK BLUE DENTAL

General Provider Information

NPI Number	:	1619972528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA P. MORELAND D.D.S.

Provider Business Mailing Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

Provider Business Practice Location Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. MARTHA P. MORELAND D.D.S.” Practice Location

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