Provider Demographics
NPI:1285693168
Name:MORA, NOE (DMD)
Entity type:Individual
Prefix:
First Name:NOE
Middle Name:
Last Name:MORA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W MARCH LN STE 1080
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2360
Mailing Address - Country:US
Mailing Address - Phone:209-951-4304
Mailing Address - Fax:209-951-8910
Practice Address - Street 1:3133 W MARCH LN STE 1080
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2360
Practice Address - Country:US
Practice Address - Phone:209-951-4304
Practice Address - Fax:209-951-8910
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3750122300000X
CA534701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431567699Medicaid