Provider Demographics
NPI:1437574761
Name:MORSE, NATALIA ANDREA (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ANDREA
Last Name:MORSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:NATALIA
Other - Middle Name:ANDREA
Other - Last Name:DIAZ SUAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:2120 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3084
Practice Address - Country:US
Practice Address - Phone:321-241-6800
Practice Address - Fax:321-241-6888
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM40481223G0001X
FLDN20867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014283100Medicaid