Provider Demographics
NPI:1023479847
Name:MORENO AND YOUNG D.D.S. P.L.L.C.
Entity type:Organization
Organization Name:MORENO AND YOUNG D.D.S. P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ASAEL
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-676-0642
Mailing Address - Street 1:3115 HOWE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5647
Mailing Address - Country:US
Mailing Address - Phone:360-676-0642
Mailing Address - Fax:360-676-1418
Practice Address - Street 1:3115 HOWE PL STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5647
Practice Address - Country:US
Practice Address - Phone:360-676-0642
Practice Address - Fax:360-676-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603588029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty