Modern Dental Professionals

NPI #1275716474 in Albertville, Minnesota

Provider Information

NPI Number: 1275716474
Entity Type: Organization
Organization Name: Modern Dental Professionals
Primary Specialty: Dentist
Enumeration Date: Dec 11, 2007
Last Updated: Dec 11, 2007

Practice Location

Address: 6563 LAKETOWNE PL
Address 2: UNIT A
City: Albertville
State: Minnesota
ZIP Code: 55301-4510
Phone: (763) 493-3600

Authorized Official

Name: DR. JEFFREY WILLIAM MOOS, DDS
Title: CEO
Phone: (715) 926-5050

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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