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NPI Code Detail

MEDICARE: DR. MICHAEL MORAN DMD

MEDICARE: DR. MICHAEL MORAN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry4059-19MS

General Provider Information

NPI Number : 1023678992
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL MORAN DMD
Provider Business Mailing Address
First Line : 106 MELISSA LN
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-3330
Country : US
Telephone Number : 601-319-5717
Fax Number :
Provider Business Practice Location Address
First Line : 1508 W 10TH ST
Second Line :
City : LAUREL
State : MS
Zip : 39440-2668
Country : US
Telephone Number : 601-428-6093
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/13/2019

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Directions to “ DR. MICHAEL MORAN DMD” Practice Location

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