Provider Demographics
NPI:1124832670
Name:MOR DENTAL IMPLANT CENTER LLC
Entity type:Organization
Organization Name:MOR DENTAL IMPLANT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-252-4229
Mailing Address - Street 1:245 BLOOMFIELD DR STE 211
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7789
Mailing Address - Country:US
Mailing Address - Phone:717-553-1793
Mailing Address - Fax:
Practice Address - Street 1:245 BLOOMFIELD DR STE 211
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7789
Practice Address - Country:US
Practice Address - Phone:717-553-1793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty