Provider Demographics
NPI:1225160138
Name:MOREAU, ROBERT J SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MOREAU
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:905 S MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3149
Mailing Address - Country:US
Mailing Address - Phone:508-337-3307
Mailing Address - Fax:508-337-3317
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3149
Practice Address - Country:US
Practice Address - Phone:508-337-3307
Practice Address - Fax:508-337-3317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA185121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12178OtherBLUE CROSS BLUE SHIELD