Provider Demographics
NPI:1417063751
Name:MORETZ, DAVID ALFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALFRED
Last Name:MORETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KEMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-9323
Mailing Address - Country:US
Mailing Address - Phone:910-389-8897
Mailing Address - Fax:
Practice Address - Street 1:122 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-5111
Practice Address - Fax:910-298-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice