Provider Demographics
NPI:1063630598
Name:MORAITIS, STUART GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:GEORGE
Last Name:MORAITIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2011
Mailing Address - Country:US
Mailing Address - Phone:954-524-0577
Mailing Address - Fax:954-524-0537
Practice Address - Street 1:1101 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2011
Practice Address - Country:US
Practice Address - Phone:954-524-0577
Practice Address - Fax:954-524-0537
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 69291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice