Individual
MARK MOORSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
907 W LINCOLN AVE, OLIVIA, MN 56277-4215
(320) 523-1441
Mailing address
907 W LINCOLN AVE, OLIVIA, MN 56277-4215
(320) 523-1441
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11030
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120523400
—
MN
Enumeration date
11/24/2009
Last updated
11/24/2009
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