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General NPI Number Information
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NPI Number | 1174835888
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Entity Type | Organization
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Legal Business Name | LUIS MORAN DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 8682 BEACH BLVD SUITE #102
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City | BUENA PARK
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State | CA
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Zip | 90620-4808
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Country | US
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Telephone | 714-484-9050
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Fax | 714-484-9060
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Provider Business Mailing Address
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Address Line | 8682 BEACH BLVD SUITE #102
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City | BUENA PARK
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State | CA
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Zip | 90620-4808
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Country | US
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Telephone | 714-484-9050
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Fax | 714-484-9060
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS MORAN
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Credential | DDS
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Telephone | 714-484-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45150
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License Number State | CA
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