Provider Demographics
NPI:1265557482
Name:MORETTI, ANTONIO J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:J
Last Name:MORETTI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRAUER HL
Mailing Address - Street 2:DEPT PERIODONTOLOGY
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:919-537-3734
Mailing Address - Fax:
Practice Address - Street 1:111 BRAUER HL
Practice Address - Street 2:DEPT PERIODONTOLOGY
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics