MEDICARE: DR. VINCENT ANTHONY MORALES D.D.S.

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	24035	TX
2	1223G0001X	General Practice Dentistry	24035	TX

General Provider Information

NPI Number	:	1790010767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT ANTHONY MORALES D.D.S.

Provider Business Mailing Address
First Line	:	6911 RANCH ROAD 620 N C-100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1825
Country	:	US
Telephone Number	:	512-249-5555
Fax Number	:	512-291-3771

Provider Business Practice Location Address
First Line	:	6911 RANCH ROAD 620 N BLDG C-100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1825
Country	:	US
Telephone Number	:	512-249-5555
Fax Number	:	512-291-3771

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	06/18/2019

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