Organization
MODERN CARE ENDODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY DAVID SIMONTON DDS (ENDODONTIST)
(952) 920-4400
Entity
Organization
Contact information
Practice address
18572 JOPLIN AVENUE, LAKEVILLE, MN 55044-4218
(952) 920-4400
(952) 882-8400
Mailing address
18572 JOPLIN AVENUE, LAKEVILLE, MN 55044-4218
(952) 920-4400
(952) 882-8400
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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