Provider Demographics
NPI:1396855466
Name:MORALES, SALVADOR A (DMD)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:A
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:AVE ESMERALDA P-11
Mailing Address - Street 2:URB PONCE DE LEON
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-3575
Mailing Address - Fax:787-720-3575
Practice Address - Street 1:AVE ESMERALDA P-11
Practice Address - Street 2:URB PONCE DE LEON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-720-3575
Practice Address - Fax:787-720-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR972122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist