Healthcare Provider Details

I. General information

NPI: 1013927656
Provider Name (Legal Business Name): JOHN MORAGA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27931 SECO CANYON RD
SAUGUS CA
91350-3872
US

IV. Provider business mailing address

27931 SECO CANYON RD
SAUGUS CA
91350-3872
US

V. Phone/Fax

Practice location:
  • Phone: 661-263-7800
  • Fax: 661-263-2403
Mailing address:
  • Phone: 661-263-7800
  • Fax: 661-263-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: