Organization
MODERN DENTAL PROFESSIONALS MN PC
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY MOOS DDS (OWNER)
(715) 829-2791
Entity
Organization
Contact information
Practice address
195 JEFFERSON BLVD, BIG LAKE, MN 55309-9572
(763) 280-5711
(763) 263-5822
Mailing address
195 JEFFERSON BLVD, BIG LAKE, MN 55309-9572
(763) 280-5711
(763) 263-5822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/05/2015
Last updated
10/05/2015
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