Provider Demographics
NPI:1174835888
Name:LUIS MORAN DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:LUIS MORAN DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-484-9050
Mailing Address - Street 1:8682 BEACH BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4808
Mailing Address - Country:US
Mailing Address - Phone:714-484-9050
Mailing Address - Fax:714-484-9060
Practice Address - Street 1:8682 BEACH BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4808
Practice Address - Country:US
Practice Address - Phone:714-484-9050
Practice Address - Fax:714-484-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty