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General NPI Number Information
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NPI Number | 1790866309
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Entity Type | Organization
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Legal Business Name | MORENO DENTAL GROUP, PDC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3427 DEER PARK DR SUITE #C
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City | STOCKTON
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State | CA
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Zip | 95219-2355
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Country | US
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Telephone | 209-478-3036
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Fax | 209-478-0258
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Provider Business Mailing Address
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Address Line | 3427 DEER PARK DR SUITE #C
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City | STOCKTON
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State | CA
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Zip | 95219-2355
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Country | US
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Telephone | 209-478-3036
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Fax | 209-478-0258
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Authorized Official
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Title or Position | PRESIDENT, TREAS.
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Name | DR. JANICE GALE MORENO
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Credential | DDS
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Telephone | 209-478-3036
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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 | 34387
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 32491
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54645
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License Number State | CA
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