Provider Demographics
NPI:1013087840
Name:L CARLOS MORALES DDS PS
Entity Type:Organization
Organization Name:L CARLOS MORALES DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-432-0561
Mailing Address - Street 1:23925 225TH WAY SE
Mailing Address - Street 2:STE A
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5233
Mailing Address - Country:US
Mailing Address - Phone:425-432-0561
Mailing Address - Fax:425-432-2938
Practice Address - Street 1:23925 225TH WAY SE
Practice Address - Street 2:STE A
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5233
Practice Address - Country:US
Practice Address - Phone:425-432-0561
Practice Address - Fax:425-432-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty