Organization
MODERN DENTAL PROFESSIONALS MINNESOTA PC
Active
Other names
Midwest Dental - Chisago City
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MOOS DDS (CEO)
(715) 926-5050
Entity
Organization
Contact information
Practice address
29663 GATEWAY AVE, CHISAGO CITY, MN 55013-0339
(651) 257-3639
Mailing address
29663 GATEWAY AVE, CHISAGO CITY, MN 55013-0339
(651) 257-3639
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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