Individual
WANDA E MORETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
4325 STAGE RD STE 2, MEMPHIS, TN 38128-5739
(901) 385-2853
(901) 385-9080
Mailing address
4325 STAGE RD STE 2, MEMPHIS, TN 38128-5739
(901) 385-2853
(901) 385-9080
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS5418
TN
1223G0001X
General Practice Dentistry
Primary
DS5418
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3225856
—
TN
Enumeration date
10/01/2007
Last updated
10/01/2007
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