Provider Demographics
NPI:1134299472
Name:MORIARTY, SEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 BLOOMFILED DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:267-255-5945
Mailing Address - Fax:
Practice Address - Street 1:245 BLOOMFILED DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543
Practice Address - Country:US
Practice Address - Phone:267-255-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101620504Medicaid
PA101620504Medicaid