Healthcare Provider Details

I. General information

NPI: 1134299472
Provider Name (Legal Business Name): SEAN MORIARTY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 BLOOMFILED DR SUITE 211
LITITZ PA
17543
US

IV. Provider business mailing address

245 BLOOMFILED DR SUITE 211
LITITZ PA
17543
US

V. Phone/Fax

Practice location:
  • Phone: 267-255-5945
  • Fax:
Mailing address:
  • Phone: 267-255-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036834
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101620504
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: