Provider Demographics
NPI:1982697256
Name:MORETZ, ROBERT LEONARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEONARD
Last Name:MORETZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N DOOLY ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1510
Mailing Address - Country:US
Mailing Address - Phone:478-472-8850
Mailing Address - Fax:478-472-8850
Practice Address - Street 1:204 N DOOLY ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063-1510
Practice Address - Country:US
Practice Address - Phone:478-472-8850
Practice Address - Fax:478-472-8850
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice