Provider Demographics
NPI:1598544025
Name:MORETTA, GUSTAVO DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:DANIEL
Last Name:MORETTA
Suffix:
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 1:5606 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3725
Mailing Address - Country:US
Mailing Address - Phone:423-877-1334
Mailing Address - Fax:
Practice Address - Street 1:5606 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3725
Practice Address - Country:US
Practice Address - Phone:423-877-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1090921223G0001X
TN126761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice