Modern Dental Professionals, Mn PC

NPI #1073796744 in Lewiston, Minnesota

Provider Information

NPI Number: 1073796744
Entity Type: Organization
Organization Name: Modern Dental Professionals, Mn PC
Primary Specialty: Dentist
Enumeration Date: Dec 17, 2007
Last Updated: Dec 17, 2007

Practice Location

Address: 560 DEBRA DR
City: Lewiston
State: Minnesota
ZIP Code: 55952-2104
Phone: (507) 523-2267

Authorized Official

Name: JEFFREY W MOOS, DDS
Title: CEO
Phone: (715) 926-5050

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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