Healthcare Provider Details

I. General information

NPI: 1952594798
Provider Name (Legal Business Name): THIAGO MORELLI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 ED DR
RALEIGH NC
27612-8037
US

IV. Provider business mailing address

3200 BLUE RIDGE RD STE 122
RALEIGH NC
27612-8087
US

V. Phone/Fax

Practice location:
  • Phone: 919-510-8888
  • Fax: 919-510-0202
Mailing address:
  • Phone: 919-510-8888
  • Fax: 919-510-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: