Provider Demographics
NPI:1295890994
Name:DR. ALICE P. MORAN, DMD, APC
Entity type:Organization
Organization Name:DR. ALICE P. MORAN, DMD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:POLEY
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-338-7103
Mailing Address - Street 1:1001 AVENIDA PICO
Mailing Address - Street 2:SUITE K
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6957
Mailing Address - Country:US
Mailing Address - Phone:949-361-4867
Mailing Address - Fax:949-361-4868
Practice Address - Street 1:1001 AVENIDA PICO
Practice Address - Street 2:SUITE K
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6957
Practice Address - Country:US
Practice Address - Phone:949-361-4867
Practice Address - Fax:949-361-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48514261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental