Healthcare Provider Details

I. General information

NPI: 1093703746
Provider Name (Legal Business Name): ALAN JOHN MORITZ DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3865
APO AE
09126
DE

IV. Provider business mailing address

UNIT 3865
APO AE
09126
DE

V. Phone/Fax

Practice location:
  • Phone: 4-965-6561
  • Fax: 8229
Mailing address:
  • Phone: 4-965-6561
  • Fax: 8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21533
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: