Organization
MODERN DENTAL PROFESSIONALS MN PC
Active
Other names
Midwest Dental - Waconia
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY W MOOS DDS (PRESIDENT - CEO)
(715) 926-5050
Entity
Organization
Contact information
Practice address
24 S OLIVE ST, WACONIA, MN 55387-1404
(952) 442-2518
(952) 442-5040
Mailing address
24 S OLIVE ST, WACONIA, MN 55387-1404
(952) 442-2518
(952) 442-5040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/24/2011
Last updated
05/24/2011
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