Healthcare Provider Details

I. General information

NPI: 1629027982
Provider Name (Legal Business Name): ENRIQUE MANUEL MORALES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC NEW ENGLAND 43 SMITH ROAD
NEWPORT RI
02841-1006
US

IV. Provider business mailing address

NH PENSACOLA 6000 W HWY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 401-841-3772
  • Fax:
Mailing address:
  • Phone: 850-452-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2506
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: