MEDICARE: CARLOS BLANCO MORALES DMD DENTIST

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	1679	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41574BL	OTHER	PR	SSS HEALTH PLAN
2	041370	OTHER	PR	CRUZ AZUL HEALTH PLAN

General Provider Information

NPI Number	:	1821127846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS BLANCO MORALES DMD DENTIST

Provider Business Mailing Address
First Line	:	CALLE DONCELLA 1632
Second Line	:	URB SAN ANTONIO
City	:	PONCE
State	:	PR
Zip	:	00728-1608
Country	:	US
Telephone Number	:	787-842-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 CALLE RAMOS ANTONINI
Second Line	:	EL TUQUE APT 1
City	:	PONCE
State	:	PR
Zip	:	00728-4700
Country	:	US
Telephone Number	:	787-841-2618
Fax Number	:	787-841-2618

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	05/17/2026

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