Provider Demographics
NPI:1316372279
Name:MORAN, ALICE P (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:P
Last Name:MORAN
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 1:1001 AVENIDA PICO STE K
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6956
Mailing Address - Country:US
Mailing Address - Phone:949-361-4867
Mailing Address - Fax:949-361-4868
Practice Address - Street 1:1001 AVENIDA PICO STE K
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6956
Practice Address - Country:US
Practice Address - Phone:949-361-4867
Practice Address - Fax:949-361-4868
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics