Provider Demographics
NPI:1770734873
Name:MORENO URIBE, LINA MARIA (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:MARIA
Last Name:MORENO URIBE
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NEWTON RD
Mailing Address - Street 2:THE UNIVERSITY OF IOWA, N401 DSB
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1010
Mailing Address - Country:US
Mailing Address - Phone:319-335-8912
Mailing Address - Fax:
Practice Address - Street 1:801 NEWTON RD
Practice Address - Street 2:THE UNIVERSITY OF IOWA, N401 DSB
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1010
Practice Address - Country:US
Practice Address - Phone:319-335-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA401091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics