Provider Demographics
NPI:1467613612
Name:MOREA, DENNIS NICHOLAS (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:NICHOLAS
Last Name:MOREA
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 1:130 FORTH WASHINGTON AVE
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4724
Mailing Address - Country:US
Mailing Address - Phone:212-928-9000
Mailing Address - Fax:212-928-6569
Practice Address - Street 1:130 FORTH WASHINGTON AVE
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4724
Practice Address - Country:US
Practice Address - Phone:212-928-9000
Practice Address - Fax:212-928-6569
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist