Individual
KENNETH J MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Mailing address
PO BOX 600, 167 NORTH MAIN STREET, TUBA CITY, AZ 86045-0600
(928) 283-2501
(928) 283-2677
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5577
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
422329
—
AZ
Enumeration date
06/08/2006
Last updated
05/25/2011
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