MEDICARE: DR. RUBEN EDMUND MORA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	23963	TX

General Provider Information

NPI Number	:	1013178813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN EDMUND MORA D.D.S.

Provider Business Mailing Address
First Line	:	529 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1636
Country	:	US
Telephone Number	:	210-547-7191
Fax Number	:	210-319-1391

Provider Business Practice Location Address
First Line	:	529 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1636
Country	:	US
Telephone Number	:	210-547-7191
Fax Number	:	210-319-1391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	04/11/2014

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