Organization
MORK DENTAL, SC
Active
Other names
Fountain City Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE M. MORK D.D.S. (OWNER)
(608) 687-3571
Entity
Organization
Contact information
Practice address
34 N MAIN ST, FOUNTAIN CITY, WI 54629-8705
(608) 687-3571
Mailing address
34 N MAIN ST, PO BOX 367, FOUNTAIN CITY, WI 54629-8705
(608) 687-3571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5882015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33814900
—
WI
Enumeration date
08/12/2008
Last updated
08/12/2008
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