Provider Demographics
NPI:1013024991
Name:MORALES, JOHN M (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MORALES
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 1:4429 S RIVER BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4658
Mailing Address - Country:US
Mailing Address - Phone:816-373-0200
Mailing Address - Fax:816-373-0581
Practice Address - Street 1:4429 S RIVER BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4658
Practice Address - Country:US
Practice Address - Phone:816-373-0200
Practice Address - Fax:816-373-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12359OtherLICENSE NUMBER