Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | IL | |
N | 1223P0300X | Periodontist | 21533 | TX |
NPI | 1093703746 |
---|---|
Provider Name | Dr. Alan John Moritz |
First Address | Apo, AE 09126 |
Second Address | Apo, AE 09126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 08/07/2007 |