Provider Demographics
NPI:1447814066
Name:MORA, MARIA JOSE (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:MORA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 W HAUSMAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4885
Mailing Address - Country:US
Mailing Address - Phone:844-764-5372
Mailing Address - Fax:
Practice Address - Street 1:5638 W HAUSMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4885
Practice Address - Country:US
Practice Address - Phone:844-764-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist