Provider Demographics
NPI:1821127846
Name:MORALES, CARLOS BLANCO (DMD DENTIST)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:BLANCO
Last Name:MORALES
Suffix:
Gender:M
Credentials:DMD DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE DONCELLA 1632
Mailing Address - Street 2:URB SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1608
Mailing Address - Country:US
Mailing Address - Phone:787-842-9166
Mailing Address - Fax:
Practice Address - Street 1:559 CALLE RAMOS ANTONINI
Practice Address - Street 2:EL TUQUE APT 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4700
Practice Address - Country:US
Practice Address - Phone:787-841-2618
Practice Address - Fax:787-841-2618
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41574BLOtherSSS HEALTH PLAN
PR041370OtherCRUZ AZUL HEALTH PLAN