Provider Demographics
NPI:1346401544
Name:MORK, ANDREW DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DEAN
Last Name:MORK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:241 N MAIN STREET
Mailing Address - City:COCHRANE
Mailing Address - State:WI
Mailing Address - Zip Code:54622
Mailing Address - Country:US
Mailing Address - Phone:608-248-2442
Mailing Address - Fax:608-248-3132
Practice Address - Street 1:1570 W SERVICE DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987
Practice Address - Country:US
Practice Address - Phone:507-452-5214
Practice Address - Fax:507-452-1338
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist