NPIMap

Organization Active NPI

Modern Dental Professionals Minnesota PC

Doing business as Midwest Dental

  • General Practice Dentistry
  • Maple Plain, MN
National Provider Identifier
1730539362
Registry record updated Jun 14, 2016
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
Practice address
1400 Baker Park Rd
Suite 1040
Maple Plain, MN 55359-9851
Phone
(763) 402-7003
Fax
(763) 447-3208
NPI assigned
Jun 14, 2016
Last updated
Jun 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Authorized official

Name
Dr. Jeffrey Moos, DDSNPI 1992827174
Title
PC Owner
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

1400 Baker Park Rd
Suite 1040
Maple Plain, MN 55359-9851

Mailing address

1400 Baker Park Rd
Suite 1040
Maple Plain, MN 55359-9851
Phone (763) 402-7003

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

1400 Baker Park Rd
Ste 1040
Maple Plain, MN 55359
Phone (763) 402-7003

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": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1730539362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BAKER PARK RD",
            "address_2": "SUITE 1040",
            "city": "MAPLE PLAIN",
            "state": "MN",
            "postal_code": "553599851",
            "telephone_number": "763-402-7003",
            "fax_number": "763-447-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BAKER PARK RD",
            "address_2": "SUITE 1040",
            "city": "MAPLE PLAIN",
            "state": "MN",
            "postal_code": "553599851",
            "telephone_number": "763-402-7003",
            "fax_number": "763-447-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MINNESOTA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "MOOS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PC OWNER",
        "authorized_official_telephone_number": "715-926-5050",
        "authorized_official_name_prefix": "Dr.",
        "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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Plain, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; 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.