MEDICARE: DR. VIVIAN SARA MORAD D.M.D.

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	1223P0300X	Periodontics	12367	FL

General Provider Information

NPI Number	:	1851730477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN SARA MORAD D.M.D.

Provider Business Mailing Address
First Line	:	8950 SW 74TH CT STE 1910
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-3178
Country	:	US
Telephone Number	:	305-670-3900
Fax Number	:	305-675-3267

Provider Business Practice Location Address
First Line	:	8950 SW 74TH CT STE 1910
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-3178
Country	:	US
Telephone Number	:	305-670-3900
Fax Number	:	305-675-3267

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	11/02/2018

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