Provider Demographics
NPI:1932596152
Name:JENNIFER MORAN, DDS, INC.
Entity Type:Organization
Organization Name:JENNIFER MORAN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-578-4600
Mailing Address - Street 1:5710 CAHALAN AVE STE 8L
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3060
Mailing Address - Country:US
Mailing Address - Phone:408-578-4600
Mailing Address - Fax:408-578-4638
Practice Address - Street 1:5710 CAHALAN AVE STE 8L
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3060
Practice Address - Country:US
Practice Address - Phone:408-578-4600
Practice Address - Fax:408-578-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA573511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty