1568681658 NPI number — LARRY J MORAY DDS, MS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568681658 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:
1568681658
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:
933 ROCKFORD ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-5323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-789-4742
Provider Business Practice Location Address Fax Number:
336-844-2283
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORAY
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
JOEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-240-7280

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  5934 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1568681658 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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