Healthcare Provider Details

I. General information

NPI: 1407999782
Provider Name (Legal Business Name): EDDY ALBERTO MORA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 CORAL WAY SUITE 217
MIAMI FL
33155-1449
US

IV. Provider business mailing address

7171 CORAL WAY SUITE 217
MIAMI FL
33155-1449
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-1620
  • Fax: 305-267-1102
Mailing address:
  • Phone: 305-267-1620
  • Fax: 305-267-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN12455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: