Modern Dental Professionals Minnesota PC
NPI #1043589484 in Chisago City, Minnesota
Provider Information
- NPI Number
- 1043589484
- Entity Type
- Organization
- Organization Name
- Modern Dental Professionals Minnesota PC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Dec 14, 2011
- Last Updated
- Dec 14, 2011
Practice Location
- Address
- 29663 GATEWAY AVE
- City
- Chisago City
- State
- Minnesota
- ZIP Code
- 55013-0339
- Phone
- (651) 257-3639
Authorized Official
- Name
- JEFFREY MOOS, DDS
- Title
- CEO
- Phone
- (715) 926-5050
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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