Provider Demographics
NPI:1699949545
Name:MOECKEL, MARIE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:ANN
Last Name:MOECKEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 CHERT DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2821
Mailing Address - Country:US
Mailing Address - Phone:619-846-3551
Mailing Address - Fax:
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1009
Practice Address - Country:US
Practice Address - Phone:858-452-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist