Provider Demographics
NPI:1417842808
Name:MORALES, DANIEL RENE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RENE
Last Name:MORALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4204
Mailing Address - Country:US
Mailing Address - Phone:773-996-0224
Mailing Address - Fax:
Practice Address - Street 1:5821 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1295
Practice Address - Country:US
Practice Address - Phone:708-529-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019036083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist