NPIMap

Organization Active NPI

Modern Dental Professionals MN PC

  • General Practice Dentistry
  • Waconia, MN
National Provider Identifier
1679866735
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS MN PC
Practice address
24 S Olive St
Waconia, MN 55387-1404
Phone
(952) 442-2518
Fax
(952) 442-5040
NPI assigned
May 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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
President - Ceo
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

24 S Olive St
Waconia, MN 55387-1404

Mailing address

24 S Olive St
Waconia, MN 55387-1404
Phone (952) 442-2518

Other names 1

  • Midwest Dental - Waconia 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

24 S Olive St
Waconia, MN 55387
Phone (952) 442-2518

Practitioners & affiliated clinicians

Practitioners 2

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": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1679866735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 S OLIVE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871404",
            "telephone_number": "952-442-2518",
            "fax_number": "952-442-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S OLIVE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871404",
            "telephone_number": "952-442-2518",
            "fax_number": "952-442-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2011-05-24",
        "status": "A",
        "authorized_official_last_name": "MOOS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT - CEO",
        "authorized_official_telephone_number": "715-926-5050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental - Waconia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.