Provider Demographics
NPI:1326214164
Name:CHART AND MOHS DENTISTRY P.A.
Entity Type:Organization
Organization Name:CHART AND MOHS DENTISTRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-727-1448
Mailing Address - Street 1:421 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1935
Mailing Address - Country:US
Mailing Address - Phone:218-727-1448
Mailing Address - Fax:218-727-0480
Practice Address - Street 1:421 E 4TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1935
Practice Address - Country:US
Practice Address - Phone:218-727-1448
Practice Address - Fax:218-727-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8120122300000X
MN8124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty