Healthcare Provider Details

I. General information

NPI: 1902536162
Provider Name (Legal Business Name): LILIANA CHRISTINA MORA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CENTRAL AVE NE
ALBUQUERQUE NM
87108-1601
US

IV. Provider business mailing address

13813 RYDERWOOD DR
HORIZON CITY TX
79928-7288
US

V. Phone/Fax

Practice location:
  • Phone: 530-518-8164
  • Fax:
Mailing address:
  • Phone: 915-355-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD5629
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: