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General NPI Number Information
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NPI Number | 1649633595
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Entity Type | Individual
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Provider Name | COLLEEN MARIE JAVIER MORENO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 7704 ELGAR ST
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City | SPRINGFIELD
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State | VA
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Zip | 22151
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Country | US
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Telephone | 571-276-4334
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Fax |
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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 | 10621
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License Number State | NC
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