Provider Demographics
NPI:1255062998
Name:MORALES, MAYLEN
Entity type:Individual
Prefix:DR
First Name:MAYLEN
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15142 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2044
Mailing Address - Country:US
Mailing Address - Phone:954-701-2794
Mailing Address - Fax:
Practice Address - Street 1:15436 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5822
Practice Address - Country:US
Practice Address - Phone:305-557-5775
Practice Address - Fax:305-557-7284
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist