Healthcare Provider Details

I. General information

NPI: 1659207579
Provider Name (Legal Business Name): DAVID MO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WABASHA ST S
SAINT PAUL MN
55107-1805
US

IV. Provider business mailing address

3685 YUMA LN N
PLYMOUTH MN
55446-2050
US

V. Phone/Fax

Practice location:
  • Phone: 763-656-8690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15505
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: