=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528447877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMIRO MORALES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2015
-----------------------------------------------------
Last Update Date | 05/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8588 STARKEY RD SUITE C
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-392-7734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8588 STARKEY RD SUITE C
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33777-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-392-7734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DN21127
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------