Organization
MODERN DENTAL PROFESSIONALS MN PC
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY MOOS DDS (OWNER)
(715) 829-2791
Entity
Organization
Contact information
Practice address
15594 PILOT KNOB RD, SUITE 100, APPLE VALLEY, MN 55124-7295
(651) 419-3840
(952) 423-1978
Mailing address
15594 PILOT KNOB RD, SUITE 100, APPLE VALLEY, MN 55124-7295
(651) 419-3840
(952) 423-1978
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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