Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 62314 | CA |
Y | 1223E0200X | Endodontist | S7-85 | NV |
NPI | 1104238120 |
---|---|
Provider Name | Dr. Miguel Roman Morales |
First Address | Henderson, NV 89012-7221 |
Second Address | Henderson, NV 89052-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2014 |
Last Update Date | 21/11/2021 |