Provider Demographics
NPI:1083610158
Name:MORITIS, ALAN EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:MORITIS
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 1:509 OLIVE WAY
Mailing Address - Street 2:STE 1520
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1700
Mailing Address - Country:US
Mailing Address - Phone:206-682-7900
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:STE 1520
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1700
Practice Address - Country:US
Practice Address - Phone:206-682-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA806531OtherUNITED CONCORDIA
WA5531009OtherD.S.H.S