Provider Demographics
NPI:1710546189
Name:MORALES, GABRIELLE MOON (DMD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MOON
Last Name:MORALES
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:MOON
Other - Last Name:NOCKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1204 TWO ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7436
Mailing Address - Country:US
Mailing Address - Phone:843-881-8881
Mailing Address - Fax:
Practice Address - Street 1:1204 TWO ISLAND CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7436
Practice Address - Country:US
Practice Address - Phone:843-881-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice