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General NPI Number Information
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NPI Number | 1255122321
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Entity Type | Individual
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Provider Name | SAMANTHA BERENICE MORA DDS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1637 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4042
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Country | US
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Telephone | 401-787-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 184 WOONASQUATUCKET AVE APT 310
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City | PROVIDENCE
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State | RI
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Zip | 02911-7122
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Country | US
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Telephone | 402-312-8490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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