Provider Demographics
NPI:1205875358
Name:MORAN, DENNIS JOHN (PHD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHN
Last Name:MORAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SW 89TH ST
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6349
Mailing Address - Country:US
Mailing Address - Phone:405-681-1227
Mailing Address - Fax:405-681-1228
Practice Address - Street 1:1601 SW 89TH ST
Practice Address - Street 2:SUITE B-100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6349
Practice Address - Country:US
Practice Address - Phone:405-681-1227
Practice Address - Fax:405-681-1228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20-1344376OtherTAX ID NUMBER
OK20-1344376OtherTAX ID NUMBER