Provider Demographics
NPI:1013178813
Name:MORA, RUBEN EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:EDMUND
Last Name:MORA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1636
Mailing Address - Country:US
Mailing Address - Phone:210-547-7191
Mailing Address - Fax:210-319-1391
Practice Address - Street 1:529 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1636
Practice Address - Country:US
Practice Address - Phone:210-547-7191
Practice Address - Fax:210-319-1391
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice