Provider Demographics
NPI:1164632113
Name:MORAGA, GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:MORAGA
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 1:25652 CROCKETT LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1635
Mailing Address - Country:US
Mailing Address - Phone:661-286-1192
Mailing Address - Fax:661-286-1092
Practice Address - Street 1:25078 PEACHLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2533
Practice Address - Country:US
Practice Address - Phone:661-287-9030
Practice Address - Fax:661-287-9032
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist