Active NPI
Robert Mork, DDS
- Dentist
- Cass Lake, MN
National Provider Identifier
1720189467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 08390
- Practice address
- 425 7TH St NW
Cass Lake, MN 56633-3360 - Phone
- (218) 335-3200
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 08390 | MN | Primary |
Addresses
Primary practice location
425 7TH St NW
Cass Lake, MN 56633-3360
Mailing address
425 7TH St NW
Cass Lake, MN 56633-3360
Phone (218) 335-3200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57G79MO | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08390 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720189467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 7TH ST NW",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "566333360",
"telephone_number": "218-335-3200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 7TH ST NW",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "566333360",
"telephone_number": "218-335-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORK",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "08390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "57G79MO",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cass Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.