Healthcare Provider Details

I. General information

NPI: 1225362684
Provider Name (Legal Business Name): DANNY MORA-GONZALEZ DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 CALLE 54 SE
SAN JUAN PR
00921-3141
US

IV. Provider business mailing address

PO BOX 363124
SAN JUAN PR
00936-3124
US

V. Phone/Fax

Practice location:
  • Phone: 939-433-4057
  • Fax: 939-649-4015
Mailing address:
  • Phone: 939-433-4057
  • Fax: 939-649-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2838
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2838
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2838
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number2838
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2838
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number2838
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2838
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2838
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2838
License Number StatePR
# 10
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2838
License Number StatePR
# 11
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number2838
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: