NPIMap

Organization Active NPI

Modern Dental Professionals, MN PC

Doing business as Midwest Dental

  • General Practice Dentistry
  • Eagan, MN
National Provider Identifier
1710357520
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS, MN PC
Doing business as
Midwest Dental
Practice address
1625 Lena CT
Suite 100
Eagan, MN 55122-2959
Phone
(651) 452-4111
Fax
(651) 452-8824
NPI assigned
Oct 6, 2015
Last updated
Oct 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

Name
Jeffrey W. Moos, DDS
Title
Owner
Phone
(715) 829-2791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1625 Lena CT
Suite 100
Eagan, MN 55122-2959

Mailing address

1625 Lena CT
Suite 100
Eagan, MN 55122-2959
Phone (651) 452-4111

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

1625 Lena Ct
Ste 100
Eagan, MN 55122
Phone (651) 452-4111

Practitioners & affiliated clinicians

Practitioners 2

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": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1710357520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 LENA CT",
            "address_2": "SUITE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222959",
            "telephone_number": "651-452-4111",
            "fax_number": "651-452-8824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 LENA CT",
            "address_2": "SUITE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222959",
            "telephone_number": "651-452-4111",
            "fax_number": "651-452-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS, MN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "MOOS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-829-2791",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.