Healthcare Provider Details

I. General information

NPI: 1548377237
Provider Name (Legal Business Name): GERARD A. MORETTI DMD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 S. CONGRESS AVE SUITE 1
LAKE WORTH FL
33461-4701
US

IV. Provider business mailing address

4765 S. CONGRESS AVE SUITE 1
LAKE WORTH FL
33461-4701
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-6600
  • Fax: 561-439-7660
Mailing address:
  • Phone: 561-439-6600
  • Fax: 561-439-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: