Provider Demographics
NPI:1780035287
Name:MORAN, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 RAVENNA AVE NE
Mailing Address - Street 2:APT 11
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4147
Mailing Address - Country:US
Mailing Address - Phone:262-442-0618
Mailing Address - Fax:
Practice Address - Street 1:5001 RAVENNA AVE NE
Practice Address - Street 2:APT 11
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4147
Practice Address - Country:US
Practice Address - Phone:262-442-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program