Modern Dental Professionals Mn PC

NPI #1215307061 in Big Lake, Minnesota

Provider Information

NPI Number: 1215307061
Entity Type: Organization
Organization Name: Modern Dental Professionals Mn PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 5, 2015
Last Updated: Oct 5, 2015

Practice Location

Address: 195 JEFFERSON BLVD
City: Big Lake
State: Minnesota
ZIP Code: 55309-9572
Phone: (763) 280-5711

Authorized Official

Name: JEFFREY MOOS, DDS
Title: OWNER
Phone: (715) 829-2791

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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