Healthcare Provider Details

I. General information

NPI: 1720081334
Provider Name (Legal Business Name): STEVEN M MORALES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 NE 223RD AVE
GRESHAM OR
97030-8554
US

IV. Provider business mailing address

387 NE 223RD AVE
GRESHAM OR
97030-8554
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-5452
  • Fax:
Mailing address:
  • Phone: 503-491-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5092
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9982
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: