Provider Demographics
NPI:1629294400
Name:JOHN MORIARTY, DDS, MS, PA
Entity Type:Organization
Organization Name:JOHN MORIARTY, DDS, MS, PA
Other - Org Name:JOHN D. MORIARTY, DDS, MS, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-929-6918
Mailing Address - Street 1:200 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1130
Mailing Address - Country:US
Mailing Address - Phone:919-929-6918
Mailing Address - Fax:919-966-0284
Practice Address - Street 1:200 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1130
Practice Address - Country:US
Practice Address - Phone:919-929-6918
Practice Address - Fax:919-966-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2479261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental