Provider Demographics
NPI:1255122321
Name:MORA, SAMANTHA BERENICE (DDS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BERENICE
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 1:184 WOONASQUATUCKET AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-7122
Mailing Address - Country:US
Mailing Address - Phone:402-312-8490
Mailing Address - Fax:
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-787-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program