Provider Demographics
NPI:1740056225
Name:MORICI, JAMIE (RDH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MORICI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HOLLOW GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5294
Mailing Address - Country:US
Mailing Address - Phone:516-761-7262
Mailing Address - Fax:
Practice Address - Street 1:3599 WINFIELD SCOTT RD
Practice Address - Street 2:STE 3401
Practice Address - City:JBSA- FSH SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-221-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024455124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist