MEDICARE: DR. VICTOR M. MOK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS036637	PA

General Provider Information

NPI Number	:	1881664696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR M. MOK DMD

Provider Business Mailing Address
First Line	:	P.O. BOX 4000
Second Line	:
City	:	POLACCA
State	:	AZ
Zip	:	86042
Country	:	US
Telephone Number	:	928-737-6085
Fax Number	:	505-722-1310

Provider Business Practice Location Address
First Line	:	HIGHWAY 264, MP 388
Second Line	:
City	:	POLACCA
State	:	AZ
Zip	:	86042
Country	:	US
Telephone Number	:	928-737-6000
Fax Number	:	505-722-1565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	10/17/2018

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