Provider Demographics
NPI:1326247073
Name:MORAN, TIAMARIE NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIAMARIE
Middle Name:NICOLE
Last Name:MORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4775 KNIGHTSBRIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4313
Mailing Address - Country:US
Mailing Address - Phone:614-824-5454
Mailing Address - Fax:
Practice Address - Street 1:4775 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4313
Practice Address - Country:US
Practice Address - Phone:614-824-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022567122300000X
PADS039002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNAOtherNA