Provider Demographics
NPI:1265678155
Name:MORA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MORA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YOSJANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-267-1620
Mailing Address - Street 1:7171 CORAL WAY STE 217
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1691
Mailing Address - Country:US
Mailing Address - Phone:305-267-1620
Mailing Address - Fax:305-267-1102
Practice Address - Street 1:7171 CORAL WAY STE 217
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1691
Practice Address - Country:US
Practice Address - Phone:305-267-1620
Practice Address - Fax:305-267-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17506302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization