Provider Demographics
NPI:1972611291
Name:MORETZ, DAWN ALLEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ALLEN
Last Name:MORETZ
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 1:503 CARTHAGE ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-775-5549
Mailing Address - Fax:919-775-7482
Practice Address - Street 1:503 CARTHAGE ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-775-5549
Practice Address - Fax:919-775-7482
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899016CMedicaid
NC9016-COtherBCBS OF NC
1300324OtherUNINTED CONCORDIA