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Individual

DR. JOHN M SKILLICORN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
186 WESTWOOD CIR, MORA, MN 55051-1731
(320) 282-8463
(320) 679-2101
Mailing address
547 UNION ST S, MORA, MN 55051-1817
(320) 679-2464
(320) 679-2101

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7519
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
635017800
MN
Enumeration date
10/18/2005
Last updated
01/08/2009
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