Provider Demographics
NPI:1831252253
Name:MORAN, CYNTHIA RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:RAE
Last Name:MORAN
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 1:4140 THIELMAN LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-7326
Mailing Address - Country:US
Mailing Address - Phone:320-252-7752
Mailing Address - Fax:320-252-2289
Practice Address - Street 1:4140 THIELMAN LN
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-7326
Practice Address - Country:US
Practice Address - Phone:320-252-7752
Practice Address - Fax:320-252-2289
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND114441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice