Provider Demographics
NPI:1306355847
Name:MORALES, NELSON ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ANTONIO
Last Name:MORALES
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 1:7578 ONEIL RD NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-1754
Mailing Address - Country:US
Mailing Address - Phone:503-409-2324
Mailing Address - Fax:
Practice Address - Street 1:30040 SW BOONES FERRY RD STE 20
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8910
Practice Address - Country:US
Practice Address - Phone:503-682-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD107331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD10733Medicaid