Provider Demographics
NPI:1528382397
Name:DEISY MON MORALES, DDS, INC
Entity Type:Organization
Organization Name:DEISY MON MORALES, DDS, INC
Other - Org Name:UNITED DENTAL OFFICE OF DEISY MON MORALES, DDS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:MOISES
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-442-6500
Mailing Address - Street 1:11912 VALLEY BLVD
Mailing Address - Street 2:STE: A
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3153
Mailing Address - Country:US
Mailing Address - Phone:626-442-6500
Mailing Address - Fax:626-442-6502
Practice Address - Street 1:11912 VALLEY BLVD
Practice Address - Street 2:STE: A
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3153
Practice Address - Country:US
Practice Address - Phone:626-442-6500
Practice Address - Fax:626-442-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA558191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty