MEDICARE: DR. DANNY MORA-GONZALEZ DMD, MS

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2838	PR
2	208600000X	Surgery Physician	2838	PR
3	2086X0206X	Surgical Oncology Physician	2838	PR
4	207ZI0100X	Immunopathology Physician	2838	PR
5	1223P0106X	Oral and Maxillofacial Pathology Dentistry	2838	PR
6	207ZC0500X	Cytopathology Physician	2838	PR
7	122300000X	Dentist	2838	PR
8	1223G0001X	General Practice Dentistry	2838	PR
9	261Q00000X	Clinic/Center	2838	PR
10	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2838	PR
11	207ZP0213X	Pediatric Pathology Physician	2838	PR

General Provider Information

NPI Number	:	1225362684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY MORA-GONZALEZ DMD, MS

Provider Business Mailing Address
First Line	:	PO BOX 363124
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-3124
Country	:	US
Telephone Number	:	939-433-4057
Fax Number	:	939-649-4015

Provider Business Practice Location Address
First Line	:	1284 CALLE 54 SE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3141
Country	:	US
Telephone Number	:	939-433-4057
Fax Number	:	939-649-4015

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	05/11/2026

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