Provider Demographics
NPI:1407999782
Name:MORA, EDDY ALBERTO (DDS)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:ALBERTO
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 1:7171 CORAL WAY
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1449
Mailing Address - Country:US
Mailing Address - Phone:305-267-1620
Mailing Address - Fax:305-267-1102
Practice Address - Street 1:7171 CORAL WAY
Practice Address - Street 2:SUITE 217
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1449
Practice Address - Country:US
Practice Address - Phone:305-267-1620
Practice Address - Fax:305-267-1102
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist