Provider Demographics
NPI:1053077123
Name:MORA-ROSA DENTAL DESIGNS, PA
Entity Type:Organization
Organization Name:MORA-ROSA DENTAL DESIGNS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMARILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES-MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-207-1800
Mailing Address - Street 1:12466 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7144
Mailing Address - Country:US
Mailing Address - Phone:407-207-1800
Mailing Address - Fax:407-207-1888
Practice Address - Street 1:12466 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7144
Practice Address - Country:US
Practice Address - Phone:407-207-1800
Practice Address - Fax:407-207-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1750469136Medicaid