MEDICARE: DR. JENNIFER L MORAN DDS

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
1	122300000X	Dentist	57351	CA

General Provider Information

NPI Number	:	1740439066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L MORAN DDS

Provider Business Mailing Address
First Line	:	130 E ROMIE LN STE C
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3159
Country	:	US
Telephone Number	:	408-375-3984
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E ROMIE LN STE C
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3159
Country	:	US
Telephone Number	:	831-424-0303
Fax Number	:	831-424-3629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	06/14/2010

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