MEDICARE: MAURICIO MOSQUERA DDS LIMITED LIABILITY COMPANY

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	261QD0000X	Dental Clinic/Center	DN19610	FL

General Provider Information

NPI Number	:	1427410695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAURICIO MOSQUERA DDS LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	820 EMMETT ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5434
Country	:	US
Telephone Number	:	407-846-6353
Fax Number	:	407-846-4831

Provider Business Practice Location Address
First Line	:	820 EMMETT ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-5434
Country	:	US
Telephone Number	:	407-846-6353
Fax Number	:	407-846-4831

Authorized Official
Title or Position	:	CEO
Name	:	MAURICIO MOSQUERA
Credential	:	DDS
Telephone Number	:	407-846-6353

Provider Enumeration Date	:	03/25/2016
Last Update Date	:	03/25/2016

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