Provider Demographics
NPI:1568509982
Name:MORALES-FERRER, LISSETTE (DMD)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:MORALES-FERRER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SECT EL ABANICO
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3804
Mailing Address - Country:US
Mailing Address - Phone:787-869-3387
Mailing Address - Fax:787-869-1986
Practice Address - Street 1:2 SECT EL ABANICO
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3804
Practice Address - Country:US
Practice Address - Phone:787-869-3387
Practice Address - Fax:787-869-1986
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3245110005Medicare UPIN