Provider Demographics
NPI:1033542618
Name:MORETZ, JESSICAH LAUREN (DDS, MS)
Entity Type:Individual
Prefix:MRS
First Name:JESSICAH
Middle Name:LAUREN
Last Name:MORETZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:MISS
Other - First Name:JESSICAH
Other - Middle Name:LAUREN
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25224 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3541
Mailing Address - Country:US
Mailing Address - Phone:803-546-3121
Mailing Address - Fax:
Practice Address - Street 1:12821 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9130
Practice Address - Country:US
Practice Address - Phone:760-947-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist