Provider Demographics
NPI:1942392261
Name:MORALES MEDINA, HECTOR F (DDS)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:F
Last Name:MORALES MEDINA
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 1:1 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2201
Mailing Address - Country:US
Mailing Address - Phone:732-345-7100
Mailing Address - Fax:732-345-7440
Practice Address - Street 1:1 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2201
Practice Address - Country:US
Practice Address - Phone:732-345-7100
Practice Address - Fax:732-345-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ196741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223566125OtherTAX ID