Provider Demographics
NPI:1427410695
Name:MAURICIO MOSQUERA DDS LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:MAURICIO MOSQUERA DDS LIMITED LIABILITY COMPANY
Other - Org Name:FAMILY FIRST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-846-6353
Mailing Address - Street 1:820 EMMETT ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5434
Mailing Address - Country:US
Mailing Address - Phone:407-846-6353
Mailing Address - Fax:407-846-4831
Practice Address - Street 1:820 EMMETT ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5434
Practice Address - Country:US
Practice Address - Phone:407-846-6353
Practice Address - Fax:407-846-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19610261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental