Provider Demographics
NPI:1164596359
Name:MORA, MARIA ESTELA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ESTELA
Last Name:MORA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 W FLAGLER ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1669
Mailing Address - Country:US
Mailing Address - Phone:305-552-8011
Mailing Address - Fax:305-226-4377
Practice Address - Street 1:10404 W FLAGLER ST STE 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1669
Practice Address - Country:US
Practice Address - Phone:305-552-8011
Practice Address - Fax:305-226-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN127581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice