Modern Dental Professionals, Minnesota PC
Dentist, General Practice in St Louis Park, MN. Organization (NPI-2).
NPI number1821356502
StatusActive
Last updated in NPPESMay 1, 2012
Details
- NPI
- 1821356502
- Entity type
- Organization (NPI-2)
- Legal business name
- Modern Dental Professionals, Minnesota PC
- Organization subpart
- No
- Enumeration date
- May 1, 2012
- Last updated
- May 1, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Midwest Dental - St. Louis Park (Doing Business As)
Practice location
3345 Dakota Ave SSt Louis Park, MN 55416-2039
Phone 952-929-9450 · Fax 952-929-1095
Mailing address
3345 Dakota Ave SSt Louis Park, MN 55416-2039
Phone 952-929-9450 · Fax 952-929-1095
Authorized official
Jeffrey W Moos
Owner
7159265050
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