Healthcare Provider Details

I. General information

NPI: 1629260021
Provider Name (Legal Business Name): LARRY J MORAY, DDS, MS PLLC VI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 MONCREIFFE RD AUITE 105A
RALEIGH NC
27617-7819
US

IV. Provider business mailing address

PO BOX 2625
CHAPEL HILL NC
27515-2625
US

V. Phone/Fax

Practice location:
  • Phone: 919-544-5700
  • Fax:
Mailing address:
  • Phone: 919-225-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5934
License Number StateNC

VIII. Authorized Official

Name: LARRY J MORAY
Title or Position: PRESIDENT
Credential: DDS
Phone: 919-225-6255