Healthcare Provider Details

I. General information

NPI: 1578783312
Provider Name (Legal Business Name): MICHAEL DAVID MORALES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CANYON RIDGE DR STE F100
AUSTIN TX
78753-1658
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 512-837-2900
  • Fax: 512-837-2901
Mailing address:
  • Phone: 210-928-2814
  • Fax: 210-928-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: