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General NPI Number Information
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NPI Number | 1104089291
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Entity Type | Organization
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Legal Business Name | MORK DENTAL SC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 50 W 2ND ST
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City | WINONA
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State | MN
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Zip | 55987-3440
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Country | US
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Telephone | 507-452-5214
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Fax |
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Provider Business Mailing Address
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Address Line | 50 W 2ND ST
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City | WINONA
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State | MN
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Zip | 55987-3440
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Country | US
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Telephone | 507-452-5214
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DESIREE M MORK
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Credential | DDS
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Telephone | 507-452-5214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12583
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08682
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12582
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License Number State | MN
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