Provider Demographics
NPI:1164040424
Name:MORETA, ALEDY MIGUELINA (DMD)
Entity Type:Individual
Prefix:
First Name:ALEDY
Middle Name:MIGUELINA
Last Name:MORETA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2122
Mailing Address - Country:US
Mailing Address - Phone:929-228-8279
Mailing Address - Fax:
Practice Address - Street 1:1813 VINEYARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2122
Practice Address - Country:US
Practice Address - Phone:929-228-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice