Provider Demographics
NPI:1659581478
Name:MORIN, JUAN M (DMD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:MORIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-4526
Mailing Address - Country:US
Mailing Address - Phone:201-866-0709
Mailing Address - Fax:201-866-6675
Practice Address - Street 1:2412 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-4526
Practice Address - Country:US
Practice Address - Phone:201-866-0709
Practice Address - Fax:201-866-6675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017806001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice