Provider Demographics
NPI:1568201127
Name:MORALES, DEVIN SEVIANO (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:SEVIANO
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 1:11600 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6606
Mailing Address - Country:US
Mailing Address - Phone:580-504-7838
Mailing Address - Fax:
Practice Address - Street 1:810 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2720
Practice Address - Country:US
Practice Address - Phone:580-323-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice