Provider Demographics
NPI:1205152899
Name:MORIARITY, JOHN D
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MORIARITY
Suffix:
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 1:2307 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2234
Mailing Address - Country:US
Mailing Address - Phone:608-213-2365
Mailing Address - Fax:
Practice Address - Street 1:2307 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2234
Practice Address - Country:US
Practice Address - Phone:608-213-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP64647122300000X
ORD9441122300000X
OK7533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist