Provider Demographics
NPI:1912359266
Name:CORTES MORALES, GUILLERMO (DMD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:CORTES MORALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 WHITEHALL DR APT 303
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6617
Mailing Address - Country:US
Mailing Address - Phone:954-243-5286
Mailing Address - Fax:
Practice Address - Street 1:1508 WHITEHALL DR APT 303
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-6617
Practice Address - Country:US
Practice Address - Phone:954-243-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist