Provider Demographics
NPI:1710136494
Name:JOHN JASON MORELAND DDS PC
Entity Type:Organization
Organization Name:JOHN JASON MORELAND DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-755-4006
Mailing Address - Street 1:7700 ALABAMA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3161
Mailing Address - Country:US
Mailing Address - Phone:915-755-4006
Mailing Address - Fax:915-755-2446
Practice Address - Street 1:7700 ALABAMA ST
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3161
Practice Address - Country:US
Practice Address - Phone:915-755-4006
Practice Address - Fax:915-755-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty