Provider Demographics
NPI:1033800255
Name:MORAMERC DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MORAMERC DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:754-265-5528
Mailing Address - Street 1:1254-56 KINGSWAY ROAD
Mailing Address - Street 2:SUITE 13-14
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510
Mailing Address - Country:US
Mailing Address - Phone:754-265-5528
Mailing Address - Fax:
Practice Address - Street 1:1254-56 KINGSWAY ROAD
Practice Address - Street 2:SUITE 13-14
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:754-265-5528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty