MEDICARE: DR. THOMAS L MORALES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	055127	NY
2	122300000X	Dentist	DE 60504242	WA

General Provider Information

NPI Number	:	1467688861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS L MORALES D.D.S.

Provider Business Mailing Address
First Line	:	3838 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4416
Country	:	US
Telephone Number	:	253-617-1175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4416
Country	:	US
Telephone Number	:	253-617-1175
Fax Number	:	253-564-4287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	11/19/2014

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