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General NPI Number Information
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NPI Number | 1316135122
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Entity Type | Organization
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Legal Business Name | JERRY MORANA, JR., DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 6117 BROCKTON AVE SUITE 103
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City | RIVERSIDE
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State | CA
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Zip | 92506-2232
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Country | US
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Telephone | 951-686-7420
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Fax | 951-686-6251
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Provider Business Mailing Address
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Address Line | 6117 BROCKTON AVE SUITE 103
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City | RIVERSIDE
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State | CA
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Zip | 92506-2232
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Country | US
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Telephone | 951-686-7420
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Fax | 951-686-6251
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY MORANA JR.
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Credential | D.D.S.
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Telephone | 951-686-7420
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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 | 43372
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License Number State | CA
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