Provider Demographics
NPI:1811066384
Name:PIERRE J MOURADIAN DMD
Entity type:Organization
Organization Name:PIERRE J MOURADIAN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOURADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-567-4949
Mailing Address - Street 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2905
Mailing Address - Country:US
Mailing Address - Phone:215-567-4949
Mailing Address - Fax:215-567-0901
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-567-4949
Practice Address - Fax:215-567-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027190L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M712033Medicare UPIN