Provider Demographics
NPI:1871237529
Name:MORANT, DWIGHT M JR
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:M
Last Name:MORANT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RYBAR LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6445
Mailing Address - Country:US
Mailing Address - Phone:138-631-4004
Mailing Address - Fax:
Practice Address - Street 1:3137 CANTERBURY ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9726
Practice Address - Country:US
Practice Address - Phone:138-621-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician