Provider Demographics
NPI:1508971417
Name:MORA, CHERYL LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LEE
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 1:888 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3301
Mailing Address - Country:US
Mailing Address - Phone:847-913-9168
Mailing Address - Fax:
Practice Address - Street 1:1220 E US HIGHWAY 45
Practice Address - Street 2:SUITE 200
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4114
Practice Address - Country:US
Practice Address - Phone:847-821-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190226041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice