Provider Demographics
NPI:1548377237
Name:MORETTI, GERARD A (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:A
Last Name:MORETTI
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4765 S. CONGRESS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4701
Mailing Address - Country:US
Mailing Address - Phone:561-439-6600
Mailing Address - Fax:561-439-7660
Practice Address - Street 1:4765 S. CONGRESS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4701
Practice Address - Country:US
Practice Address - Phone:561-439-6600
Practice Address - Fax:561-439-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL62301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL85353ZMedicare UPIN