Organization
MODERN DENTAL PROFESSIONALS, MN PC
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY W MOOS DDS (CEO)
(715) 926-5050
Entity
Organization
Contact information
Practice address
560 DEBRA DR, LEWISTON, MN 55952-2104
(507) 523-2267
Mailing address
560 DEBRA DR, LEWISTON, MN 55952-2104
(507) 523-2267
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11386
MN
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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