Provider Demographics
NPI:1356494330
Name:MORALES, RAFAEL DARIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:DARIO
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 1:615 NW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-392-3970
Practice Address - Fax:561-392-0122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice