Provider Demographics
NPI:1255763116
Name:MORANDI, STEVEN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:MORANDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9114
Mailing Address - Country:US
Mailing Address - Phone:831-338-1888
Mailing Address - Fax:831-338-5005
Practice Address - Street 1:12880 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9114
Practice Address - Country:US
Practice Address - Phone:831-338-1888
Practice Address - Fax:831-338-5005
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice