Provider Demographics
NPI:1205806684
Name:MORALES-MORALES, JOSE A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:MORALES-MORALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29736
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0736
Mailing Address - Country:US
Mailing Address - Phone:787-755-4347
Mailing Address - Fax:787-283-7440
Practice Address - Street 1:65 INFANTERIA AVE. CONCORDIA SHOPPING CTR.
Practice Address - Street 2:570 CALLE NAPOLES SUITE 208
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924-4605
Practice Address - Country:US
Practice Address - Phone:787-755-4347
Practice Address - Fax:787-283-7440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR008431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT70612Medicare UPIN