Provider Demographics
NPI:1710036553
Name:MORANDO, GREGORY (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MORANDO
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 1:189 BOULTON CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4137
Mailing Address - Country:US
Mailing Address - Phone:256-325-0297
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL CLINIC COMMAND
Practice Address - Street 2:INNKEEPER ST. BUILDING 4405
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics