Active NPI
John M Skillicorn, D.D.S.
- General Practice Dentistry
- Mora, MN
National Provider Identifier
1760471106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D7519
- Practice address
- 186 Westwood Cir
Mora, MN 55051-1731 - Phone
- (320) 282-8463
- Fax
- (320) 679-2101
- NPI assigned
- Oct 18, 2005
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D7519 | MN | Primary |
Addresses
Primary practice location
186 Westwood Cir
Mora, MN 55051-1731
Mailing address
547 Union St S
Mora, MN 55051-1817
Phone (320) 679-2464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 635017800 | Medicaid | MN |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7519 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mora Dental Center | Past | Accepting new patients | |
| Mora Dental Center LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Mora, MN
- NPI 1700065687
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231372800000",
"number": "1760471106",
"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": "320-679-2464",
"fax_number": "320-679-2101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 WESTWOOD CIR",
"city": "MORA",
"state": "MN",
"postal_code": "550511731",
"telephone_number": "320-282-8463",
"fax_number": "320-679-2101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKILLICORN",
"first_name": "JOHN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2009-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D7519",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "635017800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}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 Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.