Provider Demographics
NPI:1972278018
Name:MORALES PADILLA, MARIANY A (DDS)
Entity Type:Individual
Prefix:
First Name:MARIANY
Middle Name:A
Last Name:MORALES PADILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1695
Mailing Address - Country:US
Mailing Address - Phone:509-961-6415
Mailing Address - Fax:
Practice Address - Street 1:1450 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1695
Practice Address - Country:US
Practice Address - Phone:509-787-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77641223G0001X
WADE61252606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice