Provider Demographics
NPI:1841031267
Name:MORAN, CHLOTIELDE (DDS)
Entity type:Individual
Prefix:
First Name:CHLOTIELDE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32674 N PICKEREL DR
Mailing Address - Street 2:
Mailing Address - City:RICHVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56576-9513
Mailing Address - Country:US
Mailing Address - Phone:763-442-5158
Mailing Address - Fax:
Practice Address - Street 1:625 TREELINE RD UNIT A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1243
Practice Address - Country:US
Practice Address - Phone:406-565-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT283811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice