Provider Demographics
NPI:1821163965
Name:MORACK INC
Entity Type:Organization
Organization Name:MORACK INC
Other - Org Name:ANDREW J MOORMANN DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-850-7799
Mailing Address - Street 1:50 BURR RIDGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0843
Mailing Address - Country:US
Mailing Address - Phone:630-850-7799
Mailing Address - Fax:
Practice Address - Street 1:50 BURR RIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0843
Practice Address - Country:US
Practice Address - Phone:630-850-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty