Provider Demographics
NPI:1487215729
Name:MORALES, JOSEPH DONATELLI
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DONATELLI
Last Name:MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1802
Mailing Address - Country:US
Mailing Address - Phone:909-647-7538
Mailing Address - Fax:
Practice Address - Street 1:1610 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3166
Practice Address - Country:US
Practice Address - Phone:951-769-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2020-02-04
Deactivation Date:2019-11-11
Deactivation Code:
Reactivation Date:2020-02-04
Provider Licenses
StateLicense IDTaxonomies
CA103865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist