Organization
MODERN DENTAL PROFESSIONALS
Active
Other names
Midwest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WILLIAM MOOS DDS (CEO)
(715) 926-5050
Entity
Organization
Contact information
Practice address
6563 LAKETOWNE PL, UNIT A, ALBERTVILLE, MN 55301-4510
(763) 493-3600
(763) 493-3602
Mailing address
6563 LAKETOWNE PL, UNIT A, ALBERTVILLE, MN 55301-4510
(763) 493-3600
(763) 493-3602
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11386
MN
Other
Enumeration date
12/11/2007
Last updated
12/11/2007
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