NPIMap

Organization Active NPI

Mora Dental Center LLC

  • Dentist
  • Mora, MN
National Provider Identifier
1144760158
Registry record updated Feb 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11774 Issued in MN
Legal business name
MORA DENTAL CENTER LLC
Doing business as
Mora Dental Center
Practice address
547 Union St S
Mora, MN 55051-1875
Phone
(320) 679-2147
Fax
(320) 679-2101
NPI assigned
Feb 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2017

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

Authorized official

Name
Dr. Jennifer Vanderpoel, DDSNPI 1881785806
Title
President
Phone
(320) 679-2147

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D11774 MN Primary

Addresses

Primary practice location

547 Union St S
Mora, MN 55051-1875

Mailing address

547 Union St S
Mora, MN 55051
Phone (320) 679-2147

Other names 1

  • Mora Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

547 Union St S
Mora, MN 55051
Phone (320) 679-2147

Practitioners & affiliated clinicians

Practitioners 2

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": "1487894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487894400000",
    "number": "1144760158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "547 UNION ST S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "55051",
            "telephone_number": "320-679-2147",
            "fax_number": "320-679-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "547 UNION ST S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511875",
            "telephone_number": "320-679-2147",
            "fax_number": "320-679-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORA DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-24",
        "last_updated": "2017-02-24",
        "status": "A",
        "authorized_official_last_name": "VANDERPOEL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-679-2147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mora Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mora, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; 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.