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General NPI Number Information
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NPI Number | 1629447305
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Entity Type | Individual
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Provider Name | JANISE MORALES
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Gender | Female
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1616 CAPE CORAL PKWY W
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City | CAPE CORAL
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State | FL
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Zip | 33914-6979
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Country | US
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Telephone | 305-903-8102
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Fax |
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Provider Business Mailing Address
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Address Line | 600 SW 11TH CT
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1251
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Country | US
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Telephone | 305-903-8102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D21303
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License Number State | FL
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