Provider Demographics
NPI:1083732531
Name:LARRY J. MORAY DDS, MS PA
Entity Type:Organization
Organization Name:LARRY J. MORAY DDS, MS PA
Other - Org Name:MYORTHODONTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MORAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:919-928-5852
Mailing Address - Street 1:5011 SOUTHPARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7738
Mailing Address - Country:US
Mailing Address - Phone:919-240-7280
Mailing Address - Fax:919-240-7316
Practice Address - Street 1:1165 GREGORY DR STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6442
Practice Address - Country:US
Practice Address - Phone:252-544-5630
Practice Address - Fax:252-631-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083732531Medicaid