Organization
MODERN DENTAL PROFESSIONALS, MN PC
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY W MOOS DDS (OWNER)
(715) 829-2791
Entity
Organization
Contact information
Practice address
2147 NORTHDALE BLVD NW, NWOOD, COON RAPIDS, MN 55433-3006
(763) 767-4888
(763) 767-4889
Mailing address
2147 NORTHDALE BLVD NW, NWOOD, COON RAPIDS, MN 55433-3006
(763) 767-4888
(763) 767-4889
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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