Provider Demographics
NPI:1700239134
Name:MORALES, JOSHUA MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MARK
Last Name:MORALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2004
Mailing Address - Country:US
Mailing Address - Phone:214-864-9938
Mailing Address - Fax:
Practice Address - Street 1:2433 S 63RD ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2004
Practice Address - Country:US
Practice Address - Phone:214-864-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001401 - 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist