NPIMap

Organization Active NPI

Modern Dental Professionals MN PC

  • Dentist
  • Maplewood, MN
National Provider Identifier
1881877553
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11386 Issued in MN
Legal business name
MODERN DENTAL PROFESSIONALS MN PC
Practice address
2355 Ariel St N
Suite a
Maplewood, MN 55109-2275
Phone
(651) 770-0428
NPI assigned
Dec 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Authorized official

Name
Jeffrey W Moos, DDS
Title
Ceo
Phone
(715) 926-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D11386 MN Primary

Addresses

Primary practice location

2355 Ariel St N
Suite a
Maplewood, MN 55109-2275

Mailing address

2355 Ariel St N
Suite a
Maplewood, MN 55109-2275
Phone (651) 770-0428

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

2355 Ariel St N
Ste A
Maplewood, MN 55109
Phone (651) 770-0428

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197849600000",
    "number": "1881877553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 ARIEL ST N",
            "address_2": "SUITE A",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092275",
            "telephone_number": "651-770-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 ARIEL ST N",
            "address_2": "SUITE A",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092275",
            "telephone_number": "651-770-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS MN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "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": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.