Provider Demographics
NPI:1992333587
Name:MOURO, ANDREW R (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:MOURO
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 1:424 HILLTOP VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-1684
Mailing Address - Country:US
Mailing Address - Phone:919-434-8825
Mailing Address - Fax:
Practice Address - Street 1:1625 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5399
Practice Address - Country:US
Practice Address - Phone:919-557-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice