Healthcare Provider Details

I. General information

NPI: 1497534549
Provider Name (Legal Business Name): MIGUEL ANGEL MORAN GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. PLUTARCO ELIAS CALLES #783 NORTE
CD.JUAREZ CHIHUAHUA
32310
MX

IV. Provider business mailing address

11425 FLOR LIATRIS
SOCORRO TX
79927
US

V. Phone/Fax

Practice location:
  • Phone: 656-185-7005
  • Fax:
Mailing address:
  • Phone: 915-215-9491
  • Fax: 915-233-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5515798
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: