NPIMap

Organization Active NPI

Modern Dental Professionals, Minnesota PC

  • Dentist
  • Saint Charles, MN
National Provider Identifier
1023250503
Registry record updated Mar 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MODERN DENTAL PROFESSIONALS, MINNESOTA PC
Practice address
931 Whitewater Ave
Saint Charles, MN 55972-1130
Phone
(507) 932-4530
NPI assigned
Mar 31, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori Pelke
Title
Professional Services Coordinator
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

931 Whitewater Ave
Saint Charles, MN 55972-1130

Mailing address

680 Hehli Way
Mondovi, WI 54755-1639
Phone (715) 926-5050

Other names 1

  • Midwest Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Midwest Dental39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

931 Whitewater Ave
Saint Charles, MN 55972
Phone (507) 932-4530

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1023250503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 HEHLI WAY",
            "city": "MONDOVI",
            "state": "WI",
            "postal_code": "547551639",
            "telephone_number": "715-926-5050",
            "fax_number": "715-926-4269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 WHITEWATER AVE",
            "city": "SAINT CHARLES",
            "state": "MN",
            "postal_code": "559721130",
            "telephone_number": "507-932-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS, MINNESOTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-31",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "PELKE",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PROFESSIONAL SERVICES COORDINATOR",
        "authorized_official_telephone_number": "715-926-5050"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Charles, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.