Provider Demographics
NPI:1548473531
Name:MOURAVIEFF, MICHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:MOURAVIEFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1612
Mailing Address - Country:US
Mailing Address - Phone:201-670-7700
Mailing Address - Fax:201-670-1311
Practice Address - Street 1:525 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1612
Practice Address - Country:US
Practice Address - Phone:201-670-7700
Practice Address - Fax:201-670-1311
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015638001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice