Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8869 | NC |
N | 1223G0001X | General Practice | 2838 | PR |
N | 213EG0000X | General Practice | 2838 | PR |
N | 1223P0106X | Oral and Maxillofacial Pathology | 2838 | PR |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 8869 | NC |
NPI | 1225362684 |
---|---|
Provider Name | Dr. Danny Mora-Gonzalez |
First Address | Mebane, NC 27302-9597 |
Second Address | Mebane, NC 27302-9597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 11/09/2014 |