Provider Demographics
NPI:1952594798
Name:MORELLI, THIAGO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THIAGO
Middle Name:
Last Name:MORELLI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BLUE RIDGE RD STE 122
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8087
Mailing Address - Country:US
Mailing Address - Phone:919-510-8888
Mailing Address - Fax:919-510-0202
Practice Address - Street 1:3200 BLUE RIDGE RD STE 122
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-510-8888
Practice Address - Fax:919-510-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108741223P0300X
MI2901019516122300000X, 1223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice