Provider Demographics
NPI:1376031344
Name:MAIRA MORALES DDS LLC
Entity Type:Organization
Organization Name:MAIRA MORALES DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-442-0331
Mailing Address - Street 1:5232 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1168
Mailing Address - Country:US
Mailing Address - Phone:305-442-0331
Mailing Address - Fax:305-442-0664
Practice Address - Street 1:5232 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1168
Practice Address - Country:US
Practice Address - Phone:305-442-0331
Practice Address - Fax:305-442-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21552261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental