Provider Demographics
NPI:1861574618
Name:MORONI, MICHAEL JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MORONI
Suffix:JR
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 1:755 S PERRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1901
Mailing Address - Country:US
Mailing Address - Phone:720-733-3440
Mailing Address - Fax:720-733-3633
Practice Address - Street 1:755 S PERRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1901
Practice Address - Country:US
Practice Address - Phone:720-733-3440
Practice Address - Fax:720-733-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice