Provider Demographics
NPI:1487633756
Name:MORENO, THOMAS JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MORENO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8132
Mailing Address - Country:US
Mailing Address - Phone:706-664-0744
Mailing Address - Fax:706-664-0747
Practice Address - Street 1:2054 WARRIOR WAY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8132
Practice Address - Country:US
Practice Address - Phone:706-664-0744
Practice Address - Fax:706-664-0747
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist