MEDICARE: DR. JOSE R MORALES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1151	PR

General Provider Information

NPI Number	:	1215932603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE R MORALES DMD

Provider Business Mailing Address
First Line	:	PO BOX 360499
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-0499
Country	:	US
Telephone Number	:	787-870-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 CALLE MUNOZ RIVERA
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00953-2427
Country	:	US
Telephone Number	:	787-870-2325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/11/2013

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