Provider Demographics
NPI:1790010767
Name:MORALES, VINCENT ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
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 1:6911 RANCH ROAD 620 N C-100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1825
Mailing Address - Country:US
Mailing Address - Phone:512-249-5555
Mailing Address - Fax:512-291-3771
Practice Address - Street 1:6911 RANCH ROAD 620 N BLDG C-100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1825
Practice Address - Country:US
Practice Address - Phone:512-249-5555
Practice Address - Fax:512-291-3771
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24035122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist