Provider Demographics
NPI:1629348081
Name:MORA, MARIA ALEJANDRA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:MORA
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:1629 S PRAIRIE AVE
Mailing Address - Street 2:UNIT 3007
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4403
Mailing Address - Country:US
Mailing Address - Phone:919-923-8729
Mailing Address - Fax:
Practice Address - Street 1:1629 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4403
Practice Address - Country:US
Practice Address - Phone:919-923-8729
Practice Address - Fax:954-374-7041
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX276061223X0008X
IL0190305381223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology