Organization
MODERN DENTAL PROFESSIONALS, MN PC
Active
Other names
Midwest Dental Renville
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MYER (CFO)
(715) 926-5050
Entity
Organization
Contact information
Practice address
107 DUPONT AVE NW, RENVILLE, MN 56284
(715) 926-5050
Mailing address
680 HEHLI WAY, MONDOVI, WI 54755-1639
(320) 329-8321
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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