Provider Demographics
NPI:1619972528
Name:MORELAND, MARTHA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:P
Last Name:MORELAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MALL DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3111
Mailing Address - Country:US
Mailing Address - Phone:319-354-1409
Mailing Address - Fax:319-354-3113
Practice Address - Street 1:1513 MALL DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3111
Practice Address - Country:US
Practice Address - Phone:319-354-1409
Practice Address - Fax:319-354-3113
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41887OtherDELTA DENTAL -DELTA USA
IA1078964Medicaid
IA41887OtherWELLMARK BLUE DENTAL