Provider Demographics
NPI:1225340979
Name:MORAN, MARIA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LOMITA BLVD # 201
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3900
Mailing Address - Country:US
Mailing Address - Phone:310-539-9300
Mailing Address - Fax:310-539-9351
Practice Address - Street 1:3600 LOMITA BLVD # 201
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3900
Practice Address - Country:US
Practice Address - Phone:310-539-9300
Practice Address - Fax:310-539-9351
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics