Modern Dental Professionals

NPI #1730788498 in Blaine, Minnesota

Provider Information

NPI Number: 1730788498
Entity Type: Organization
Organization Name: Modern Dental Professionals
Primary Specialty: Dentist
Enumeration Date: Oct 22, 2020
Last Updated: Oct 22, 2020

Practice Location

Address: 676 COUNTY ROAD 10 NE
City: Blaine
State: Minnesota
ZIP Code: 55434-2329
Phone: (763) 780-5007

Authorized Official

Name: BRENT ALTHOFF
Title: CREDENTIALING MANAGER
Phone: (715) 203-4689

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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