Provider Demographics
NPI:1194749838
Name:MORAN, JEANNIE HARRIS (DMD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:HARRIS
Last Name:MORAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 8TH ST S
Mailing Address - Street 2:STE A
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6109
Mailing Address - Country:US
Mailing Address - Phone:239-261-1401
Mailing Address - Fax:239-261-1854
Practice Address - Street 1:77 8TH ST S
Practice Address - Street 2:STE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6109
Practice Address - Country:US
Practice Address - Phone:239-261-1401
Practice Address - Fax:239-261-1854
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics