NPIMap

Organization Active NPI

Modern Dental Professionals

  • Dentist
  • Blaine, MN
National Provider Identifier
1730788498
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MODERN DENTAL PROFESSIONALS
Practice address
676 County Road 10 NE
Blaine, MN 55434-2329
Phone
(763) 780-5007
NPI assigned
Oct 22, 2020
Last updated
Oct 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Authorized official

Name
Brent Althoff
Title
Credentialing Manager
Phone
(715) 203-4689

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

676 County Road 10 NE
Blaine, MN 55434-2329

Mailing address

676 County Road 10 NE
Blaine, MN 55434-2329
Phone (763) 780-5007

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address blaine@midwest-dental.com Direct

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

676 County Road 10 NE
Blaine, MN 55434
Phone (763) 780-5007

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": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1730788498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 COUNTY ROAD 10 NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554342329",
            "telephone_number": "763-780-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 COUNTY ROAD 10 NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554342329",
            "telephone_number": "763-780-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "ALTHOFF",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "715-203-4689"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "blaine@midwest-dental.com",
            "affiliation": "N",
            "endpointDescription": "Office email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "676 County Road 10 NE",
            "city": "Blaine",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554342329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.