Modern Dental Professionals Minnesota PC

Organization Active NPI General Practice Dentistry · Victoria, MN

NPI 1194053173 · NPPES record last updated Dec 2, 2009

Key facts

NPI
1194053173
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS MINNESOTA PC
Practice address
1405 78TH St
Victoria, MN 55386-9723
Phone
(952) 443-2994
Fax
(952) 443-2918
NPI assigned
Dec 2, 2009
Organization subpart
No

Authorized official

Name
James Myer
Title
Cfo
Phone
(715) 926-5050

Corporate family (same tax ID) 38

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

View all 38

National Provider Directory

Tax ID family
Midwest Dental (39 organizations share this tax ID)

Locations

1405 78th St
Victoria, MN 55386
Phone (952) 443-0015

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X Yes

Addresses

Primary practice location

1405 78TH St
Victoria, MN 55386-9723

Mailing address

1405 78TH St
Victoria, MN 55386-9723
Phone (952) 443-2994

Other names

  • Midwest Dental Doing business as

Other providers in Victoria, MN

All providers in Victoria, MN · General Practice Dentistry in Minnesota

Sources for this page

Verify at the official NPI Registry.