MEDICARE: DR. MICHAEL DAVID MORA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019018620	IL

General Provider Information

NPI Number	:	1154436236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID MORA D.D.S.

Provider Business Mailing Address
First Line	:	1220 E US HIGHWAY 45
Second Line	:	SUITE 200
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4114
Country	:	US
Telephone Number	:	847-913-9168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 E US HIGHWAY 45
Second Line	:	SUITE 200
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4114
Country	:	US
Telephone Number	:	847-821-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/03/2015

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Directions to “ DR. MICHAEL DAVID MORA D.D.S.” Practice Location

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