Provider Demographics
NPI:1194479386
Name:MORAN, HAYLEEN E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:HAYLEEN
Middle Name:E
Last Name:MORAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WARING AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7714
Mailing Address - Country:US
Mailing Address - Phone:347-935-8954
Mailing Address - Fax:
Practice Address - Street 1:54 WARREN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1078
Practice Address - Country:US
Practice Address - Phone:212-561-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0622991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics