NPIMap

Organization Active NPI

Modern Dental Professionals Minnesota PC

Doing business as Midwest Dental - Wells

  • General Practice Dentistry
  • Wells, MN
National Provider Identifier
1316216377
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS MINNESOTA PC
Doing business as
Midwest Dental - Wells
Practice address
150 3Rd St NW
Wells, MN 56097-1021
Phone
(507) 553-5085
Fax
(507) 553-5948
NPI assigned
Dec 21, 2011
Last updated
Dec 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Authorized official

Name
Jeffrey W. Moos, DDSNPI 1992827174
Title
Ceo
Phone
(715) 926-5050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

150 3Rd St NW
Wells, MN 56097-1021

Mailing address

150 3Rd St NW
Wells, MN 56097-1021
Phone (507) 553-5085

Other names 1

  • Midwest Dental - Wells 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1316216377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 3RD ST NW",
            "city": "WELLS",
            "state": "MN",
            "postal_code": "560971021",
            "telephone_number": "507-553-5085",
            "fax_number": "507-553-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 3RD ST NW",
            "city": "WELLS",
            "state": "MN",
            "postal_code": "560971021",
            "telephone_number": "507-553-5085",
            "fax_number": "507-553-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MINNESOTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2011-12-21",
        "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_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental - Wells",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wells, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.