Provider Demographics
NPI:1548005309
Name:MORALES, MAIKOL JESUS (DMD)
Entity type:Individual
Prefix:DR
First Name:MAIKOL
Middle Name:JESUS
Last Name:MORALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 LOCH DOON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2776
Mailing Address - Country:US
Mailing Address - Phone:786-302-9873
Mailing Address - Fax:
Practice Address - Street 1:2360 W 68TH ST STE 124
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5502
Practice Address - Country:US
Practice Address - Phone:305-825-7447
Practice Address - Fax:786-534-9399
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist