Provider Demographics
NPI:1568004570
Name:MOREDENTAL, P.L.L.C.
Entity Type:Organization
Organization Name:MOREDENTAL, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-643-7811
Mailing Address - Street 1:501 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1605
Mailing Address - Country:US
Mailing Address - Phone:361-643-7811
Mailing Address - Fax:361-643-4028
Practice Address - Street 1:501 MOORE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1605
Practice Address - Country:US
Practice Address - Phone:361-643-7811
Practice Address - Fax:361-643-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972717445OtherNPI