1710036553 NPI number — GREGORY MORANDO D.M.D

Table of content: GREGORY MORANDO D.M.D (NPI 1710036553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710036553 NPI number — GREGORY MORANDO D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORANDO
Provider First Name:
GREGORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710036553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
189 BOULTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35756-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-325-0297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US ARMY DENTAL CLINIC COMMAND
Provider Second Line Business Practice Location Address:
INNKEEPER ST. BUILDING 4405
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-9285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  6596 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)