Healthcare Provider Details

I. General information

NPI: 1396855029
Provider Name (Legal Business Name): DANIEL THOMAS MORAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51A NORTH FERRY RD
SHELTER ISLAND NY
11964-2008
US

IV. Provider business mailing address

PO BOX 2008
SHELTER ISLAND NY
11964-2008
US

V. Phone/Fax

Practice location:
  • Phone: 631-749-0539
  • Fax: 631-749-0539
Mailing address:
  • Phone: 631-749-0539
  • Fax: 631-749-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number038322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: