NPIMap

Organization Active NPI

Modern Dental Professionals, MN PC

  • Dentist
  • Zumbrota, MN
National Provider Identifier
1295965572
Registry record updated Jul 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11386 Issued in MN
Legal business name
MODERN DENTAL PROFESSIONALS, MN PC
Practice address
379 S Main St
Zumbrota, MN 55992-1543
Phone
(507) 732-5346
Fax
(507) 732-5655
NPI assigned
Jul 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2009

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

Authorized official

Name
Dr. Jeffrey W. Moos, DDS
Title
Ceo
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D11386 MN Primary

Addresses

Primary practice location

379 S Main St
Zumbrota, MN 55992-1543

Mailing address

379 S Main St
Zumbrota, MN 55992-1543
Phone (507) 732-5346

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

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": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248134400000",
    "number": "1295965572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 S MAIN ST",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "559921543",
            "telephone_number": "507-732-5346",
            "fax_number": "507-732-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 S MAIN ST",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "559921543",
            "telephone_number": "507-732-5346",
            "fax_number": "507-732-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS, MN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2009-07-21",
        "status": "A",
        "authorized_official_last_name": "MOOS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-926-5050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zumbrota, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.