=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487031852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER L. MORAN, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2015
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 E ROMIE LN STE C
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-0303
-----------------------------------------------------
Fax | 831-424-3629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 E ROMIE LN STE C
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-0303
-----------------------------------------------------
Fax | 831-424-3629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JENNIFER MORAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 831-424-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | CA57351
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------