Individual
MARK JOHN MODJEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7001 NICOLLET AVE, RICHFIELD, MN 55423-3162
(612) 866-3322
Mailing address
7001 NICOLLET AVE, RICHFIELD, MN 55423-3162
(612) 866-3322
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8439
MN
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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