Organization
MODERN DENTAL PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT ALTHOFF (CREDENTIALING MANAGER)
(715) 203-4689
Entity
Organization
Contact information
Practice address
676 COUNTY ROAD 10 NE, BLAINE, MN 55434-2329
(763) 780-5007
Mailing address
676 COUNTY ROAD 10 NE, BLAINE, MN 55434-2329
(763) 780-5007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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