Provider Demographics
NPI:1487031852
Name:JENNIFER L. MORAN, DDS, INC
Entity Type:Organization
Organization Name:JENNIFER L. MORAN, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-424-0303
Mailing Address - Street 1:130 E ROMIE LN STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3159
Mailing Address - Country:US
Mailing Address - Phone:831-424-0303
Mailing Address - Fax:831-424-3629
Practice Address - Street 1:130 E ROMIE LN STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3159
Practice Address - Country:US
Practice Address - Phone:831-424-0303
Practice Address - Fax:831-424-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA573511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty