Organization
MORK DENTAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE M MORK DDS (DENTIST/OWNER)
(507) 452-5214
Entity
Organization
Contact information
Practice address
50 W 2ND ST, WINONA, MN 55987-3440
(507) 452-5214
Mailing address
50 W 2ND ST, WINONA, MN 55987-3440
(507) 452-5214
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
08682
MN
1223G0001X
General Practice Dentistry
Primary
D12582
MN
1223G0001X
General Practice Dentistry
D12583
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215518400
—
MN
05
—
33814900
—
WI
Enumeration date
07/08/2008
Last updated
08/12/2008
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