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General NPI Number Information
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NPI Number | 1588994123
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Entity Type | Organization
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Legal Business Name | DC MORA DDS
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 1464 S CIRCLE ST
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City | SEALY
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State | TX
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Zip | 77474-3914
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Country | US
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Telephone | 979-627-7779
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Fax | 979-627-7203
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Provider Business Mailing Address
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Address Line | 1464 S CIRCLE ST
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City | SEALY
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State | TX
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Zip | 77474-3914
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Country | US
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Telephone | 979-627-7779
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Fax | 979-627-7203
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOLORES C MORA
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Credential | DDS
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Telephone | 281-391-8882
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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 | 20024
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License Number State | TX
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