Healthcare Provider Details

I. General information

NPI: 1588126114
Provider Name (Legal Business Name): SKYLER MODEROW MULLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 2ND AVE N # 1
GRAND FORKS ND
58203-3427
US

IV. Provider business mailing address

1323 2ND AVE N # 1
GRAND FORKS ND
58203-3427
US

V. Phone/Fax

Practice location:
  • Phone: 701-775-4289
  • Fax:
Mailing address:
  • Phone: 701-775-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2375
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: