Healthcare Provider Details

I. General information

NPI: 1457310559
Provider Name (Legal Business Name): CARLOS A. MORALES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15858 SW WARFIELD BLVD
INDIANTOWN FL
34956-3513
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 772-597-3596
  • Fax: 772-597-4194
Mailing address:
  • Phone: 561-844-9443
  • Fax: 561-472-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN13607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: