Provider Demographics
NPI:1518058494
Name:MORANDA, ANNETTE BAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:BAK
Last Name:MORANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80641 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-1818
Mailing Address - Country:US
Mailing Address - Phone:760-346-8011
Mailing Address - Fax:760-341-6836
Practice Address - Street 1:39700 BOB HOPE DR STE 220
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7111
Practice Address - Country:US
Practice Address - Phone:760-346-8011
Practice Address - Fax:760-341-6836
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA487011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice