NPIMap

Organization Active NPI

Mork Dental SC

  • General Practice Dentistry
  • Winona, MN
National Provider Identifier
1104089291
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12582 Issued in MN
Legal business name
MORK DENTAL SC
Practice address
50 W 2ND St
Winona, MN 55987-3440
Phone
(507) 452-5214
NPI assigned
Jul 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Desiree M Mork, DDS
Title
Dentist/Owner
Phone
(507) 452-5214

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D12583 MN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D12582 MN Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 08682 MN

Addresses

Primary practice location

50 W 2ND St
Winona, MN 55987-3440

Mailing address

50 W 2ND St
Winona, MN 55987-3440
Phone (507) 452-5214

Other identifiers 2

IdentifierTypeStateIssuer
33814900MedicaidWI
215518400MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Mork Dental SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1104089291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W 2ND ST",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559873440",
            "telephone_number": "507-452-5214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 W 2ND ST",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559873440",
            "telephone_number": "507-452-5214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORK DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-08",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "MORK",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "507-452-5214",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12583",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12582",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "08682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33814900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215518400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.