Provider Demographics
NPI:1346931565
Name:MORALES, MARYANN (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 CHERRY ST APT V
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8093
Mailing Address - Country:US
Mailing Address - Phone:786-897-1961
Mailing Address - Fax:
Practice Address - Street 1:340 MAGNOLIA CIRCLE TYNDALL AFB
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32403
Practice Address - Country:US
Practice Address - Phone:850-283-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant