Provider Demographics
NPI:1104238120
Name:MORALES, MIGUEL ROMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ROMAN
Last Name:MORALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 LATINA CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-7221
Mailing Address - Country:US
Mailing Address - Phone:310-795-0683
Mailing Address - Fax:
Practice Address - Street 1:10960 S EASTERN AVE STE 112
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4974
Practice Address - Country:US
Practice Address - Phone:702-485-5455
Practice Address - Fax:702-485-5464
Is Sole Proprietor?:No
Enumeration Date:2014-05-25
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623141223E0200X
NVS7-851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics