Provider Demographics
NPI:1649328758
Name:MOREN, DENNIS ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROBERT
Last Name:MOREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CROSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMONDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12149-1722
Mailing Address - Country:US
Mailing Address - Phone:518-294-6542
Mailing Address - Fax:
Practice Address - Street 1:106 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4605
Practice Address - Country:US
Practice Address - Phone:518-234-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041422-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist