Individual
DR. STEPHEN MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-6511
(619) 532-6400
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401418390
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
100401
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN26788
FL
Other
Enumeration date
09/01/2016
Last updated
07/19/2024
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