Provider Demographics
NPI:1760033047
Name:BRYAN B MORADI DDS PA
Entity Type:Organization
Organization Name:BRYAN B MORADI DDS PA
Other - Org Name:RIDGEVIEW DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-672-1000
Mailing Address - Street 1:2649 ANNAPOLIS RD STE D
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1290
Mailing Address - Country:US
Mailing Address - Phone:410-672-1000
Mailing Address - Fax:
Practice Address - Street 1:2649 ANNAPOLIS RD STE D
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1290
Practice Address - Country:US
Practice Address - Phone:410-672-1000
Practice Address - Fax:410-672-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty