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General NPI Number Information
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NPI Number | 1114154952
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Entity Type | Organization
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Legal Business Name | ROSA MORA D.D.S
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 921 E MAIN AVE SUITE2
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City | ALTON
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State | TX
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Zip | 78573-0952
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Country | US
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Telephone | 956-583-5050
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Fax | 956-583-5067
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Provider Business Mailing Address
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Address Line | 921 E MAIN AVE SUITE 2
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City | MISSION
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State | TX
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Zip | 78573
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Country | US
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Telephone | 956-583-5050
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Fax | 956-583-5067
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ROSA MORA
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Credential | DDS
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Telephone | 956-583-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20419
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License Number State | TX
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