Provider Demographics
NPI:1962614057
Name:FIDLER, MOREL (DDS)
Entity type:Individual
Prefix:DR
First Name:MOREL
Middle Name:
Last Name:FIDLER
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 1:6222 WILSHIRE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5193
Mailing Address - Country:US
Mailing Address - Phone:323-935-1882
Mailing Address - Fax:323-935-1897
Practice Address - Street 1:6222 WILSHIRE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5193
Practice Address - Country:US
Practice Address - Phone:323-935-1882
Practice Address - Fax:323-935-1897
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA184661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice