Provider Demographics
NPI:1689915084
Name:DEVARIE MORALES, AIXA YARI (DMD)
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:YARI
Last Name:DEVARIE MORALES
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 1:2247 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7975
Mailing Address - Country:US
Mailing Address - Phone:503-689-8584
Mailing Address - Fax:
Practice Address - Street 1:2247 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7975
Practice Address - Country:US
Practice Address - Phone:503-689-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9856122300000X
PR3394122300000X
390200000X
ORD10445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program