MEDICARE: DR. MAYLEN MORALES

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	122300000X	Dentist	27070	FL

General Provider Information

NPI Number	:	1255062998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYLEN MORALES

Provider Business Mailing Address
First Line	:	15142 SW 17TH ST
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33326-2044
Country	:	US
Telephone Number	:	954-701-2794
Fax Number	:

Provider Business Practice Location Address
First Line	:	15436 NW 77TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5822
Country	:	US
Telephone Number	:	305-557-5775
Fax Number	:	305-557-7284

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

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	07/12/2022

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Directions to “ DR. MAYLEN MORALES ” Practice Location

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