Provider Demographics
NPI:1982771622
Name:MARIA ESTELA MORA DDS, INC.
Entity Type:Organization
Organization Name:MARIA ESTELA MORA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ESTELA
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-887-0387
Mailing Address - Street 1:1051 W 29TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5057
Mailing Address - Country:US
Mailing Address - Phone:305-887-0387
Mailing Address - Fax:305-887-2089
Practice Address - Street 1:1051 W 29TH ST STE 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5057
Practice Address - Country:US
Practice Address - Phone:305-887-0387
Practice Address - Fax:305-887-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 127581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty