Provider Demographics
NPI:1518231133
Name:MORAVEJ DENTAL CORPORATION
Entity Type:Organization
Organization Name:MORAVEJ DENTAL CORPORATION
Other - Org Name:MEMORIAL CITY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAVEJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-492-4142
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE # 166
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-461-6161
Mailing Address - Fax:713-461-4282
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:SUITE # 166
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-461-6161
Practice Address - Fax:713-461-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty