Mork Dental, SC

Primary specialty

DentistTaxonomy code 122300000X

License

5882015 Issued in WI

Legal business name

MORK DENTAL, SC

Doing business as

Fountain City Family Dentistry

Practice address

34 N Main St
Fountain City, WI 54629-8705

Phone

(608) 687-3571

NPI assigned

Aug 12, 2008

Last updated

Aug 12, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Desiree M. Mork, D.D.S.

Title

Owner

Phone

(608) 687-3571

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fountain City Family Dentistry Doing business as

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

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1457507329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 N MAIN ST",
            "address_2": "PO BOX 367",
            "city": "FOUNTAIN CITY",
            "state": "WI",
            "postal_code": "546298705",
            "telephone_number": "608-687-3571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 N MAIN ST",
            "city": "FOUNTAIN CITY",
            "state": "WI",
            "postal_code": "546298705",
            "telephone_number": "608-687-3571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORK DENTAL, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-12",
        "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": "OWNER",
        "authorized_official_telephone_number": "608-687-3571",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5882015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33814900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain City Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherry J Foust, MS, CCC-SLP
• Kyle William Grimes, D.C.
• Samantha Grimes, D.C.
• Nicole L Kemp, PTA
• Cheryl Thomas Kuhn, MS CCC-SLP
• Barbara Ann Parent, OTR
• Daniel J Ramer, RPH
• Therese Schaffner
• Joan M Schnabel, MD
• School District of Cochrane-Fountain City

• Dentist in Fountain City, WI
• Providers in Fountain City, WI by specialty
• Dentist in Wisconsin

• 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.