Provider Demographics
NPI:1215932603
Name:MORALES, JOSE R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
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:PO BOX 360499
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0499
Mailing Address - Country:US
Mailing Address - Phone:787-870-2325
Mailing Address - Fax:
Practice Address - Street 1:63 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2427
Practice Address - Country:US
Practice Address - Phone:787-870-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice