Provider Demographics
NPI:1528285145
Name:MORNEAU, GINETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:GINETTE
Middle Name:
Last Name:MORNEAU
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 1:14097 LOTUS LN APT 1627
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-7405
Mailing Address - Country:US
Mailing Address - Phone:443-851-8933
Mailing Address - Fax:
Practice Address - Street 1:10680 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3811
Practice Address - Country:US
Practice Address - Phone:703-385-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134021223G0001X
VA04014112351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice