1770795817 NPI number — LARRY J. MORAY DDS, MS, PA

Table of content: (NPI 1770795817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770795817 NPI number — LARRY J. MORAY DDS, MS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARRY J. MORAY DDS, MS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MYORTHODONTIST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770795817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5011 SOUTHPARK DR STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-7738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-240-7280
Provider Business Mailing Address Fax Number:
919-240-7316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 CHURCH ST N STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-784-3611
Provider Business Practice Location Address Fax Number:
47-213-2247
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORAY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
919-240-7280

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1770795817 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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