Provider Demographics
NPI:1649397530
Name:MORAN, LUIS E (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:MORAN
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 1:8682 BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4808
Mailing Address - Country:US
Mailing Address - Phone:714-484-9050
Mailing Address - Fax:
Practice Address - Street 1:8682 BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4808
Practice Address - Country:US
Practice Address - Phone:714-484-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice