Individual
DR. CAROL LYNN MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
1205 N COLUMBUS ST, WEST LIBERTY, IA 52776-9601
(319) 627-2612
(319) 627-2178
Mailing address
1205 N COLUMBUS ST, WEST LIBERTY, IA 52776-9601
(319) 627-2612
(319) 627-2178
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6899
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1216853
—
IA
Enumeration date
08/31/2006
Last updated
09/11/2012
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