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General NPI Number Information
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NPI Number | 1245683820
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Entity Type | Individual
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Provider Name | ANIA C MORENO DMD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 5526 BERGENLINE AVE STE 2
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-4670
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Country | US
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Telephone | 201-590-9500
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Fax | 201-430-8207
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Provider Business Mailing Address
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Address Line | 400 HARRISON AVE
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City | HARRISON
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State | NJ
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Zip | 07029-1720
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Country | US
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Telephone | 973-484-0979
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Fax | 973-484-9608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02646500
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License Number State | NJ
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