Organization
MORA DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENY CHACKO D.D.S. (DENTIST)
(320) 679-2147
Entity
Organization
Contact information
Practice address
547 UNION ST S, MORA, MN 55051-1817
(320) 679-2147
(320) 679-2101
Mailing address
547 UNION ST S, MORA, MN 55051-1817
(320) 679-2147
(320) 679-2101
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11844
MN
Other
Enumeration date
10/29/2007
Last updated
10/29/2007
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