Mora Dental Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

11844 Issued in MN

Legal business name

MORA DENTAL CENTER

Practice address

547 Union St S
Mora, MN 55051-1817

Phone

(320) 679-2147

Fax

(320) 679-2101

NPI assigned

Oct 29, 2007

Organization subpart

No

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

Authorized official

Name

Reny Chacko, D.D.S.

Title

Dentist

Phone

(320) 679-2147

Specialties & licenses 1

Addresses

Practitioners 2

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

• John M Skillicorn, D.D.S.

  • General Practice Dentistry
  • Mora, MN
  • NPI 1760471106
  NPD (past)
• Jennifer Vanderpoel, DDS

  • General Practice Dentistry
  • Mora, MN
  • NPI 1881785806
  NPD (past)

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1700065687",
    "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": "550511817",
            "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": "550511817",
            "telephone_number": "320-679-2147",
            "fax_number": "320-679-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORA DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "CHACKO",
        "authorized_official_first_name": "RENY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "320-679-2147",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "11844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Lynn McDermeit, DPT
• Ronald K Menk, MD
• Melissa L Merrick
• Amy Miller, SLP
• Mora Chiropractic Clinic P.C.
• Mora Dental Center LLC
• Mora Housing and Redevelopment Authority
• Gordon Troy Mork, OD
• Jean Mork, PT
• Joseph Troy Mork, OD

• Dental Clinic/Center in Mora, MN
• Providers in Mora, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; 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.