MODERN DENTAL PROFESSIONALS, MN PC (NPI# 1710357520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710357520 |
| Entity Type | Organization |
| Organization Name | MODERN DENTAL PROFESSIONALS, MN PC |
| Other Organization Name | MIDWEST DENTAL |
| Practice Address |
1625 Lena Ct Suite 100 Eagan MN 55122-2959 |
| Practice Telephone | 6514524111 |
| Practice Fax Number | 6514528824 |
| Mailing Telephone | 6514524111 |
| Mailing Fax Number | 6514528824 |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2015-10-06 |
| Authorized Official Name | JEFFREY W. MOOS (OWNER) |
| Authorized Official Telephone | 7158292791 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Midwest Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770939613 | Modern Dental Professionals, Mn PC | Dentist | 20700 Chippendale Ave W, Suite 10, Farmington, MN 55024-8207 | 2016-05-10 |
| 1003286808 | Modern Dental Professionals, Mn PC | Dentist | 2147 Northdale Blvd Nw, Nwood, Coon Rapids, MN 55433-3006 | 2015-10-06 |
| 1144513565 | Modern Dental Professionals, Mn PC | Dentist | 507 S Shore Dr, Worthington, MN 56187-1400 | 2011-05-18 |
| 1710358379 | Modern Dental Professionals, Mn PC | Dentist | 7532 Brooklyn Blvd, Brooklyn Park, MN 55443-3101 | 2015-10-08 |
| 1881060069 | Modern Dental Professionals, Mn PC | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2015-08-11 |
| 1558643817 | Modern Dental Professionals, Mn PC | Dentist | 4140 Thielman Ln, Suite 302, Saint Cloud, MN 56301-7326 | 2011-09-13 |
| 1679853451 | Modern Dental Professionals, Mn PC | Dentist | 107 Dupont Ave Nw, Renville, MN 56284 | 2011-08-24 |
| 1295965572 | Modern Dental Professionals, Mn PC | Dentist | 379 S Main St, Zumbrota, MN 55992-1543 | 2009-07-21 |
| 1073796744 | Modern Dental Professionals, Mn PC | Dentist | 560 Debra Dr, Lewiston, MN 55952-2104 | 2007-12-17 |
| 1124159983 | Modern Dental Professionals, Mn PC | Dentist | 680 Hehli Way, Mondovi, WI 54755-1639 | 2007-03-07 |
| Street Address |
1625 LENA CT SUITE 100 |
| City | EAGAN |
| State | MN |
| Zip Code | 55122-2959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346867553 | Jane Laporte | Dentist | 1625 Lena Ct, #100, Eagan, MN 55122 | 2020-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730651753 | Alvaro Jesus Jimenez Aguilar | Registered Nurse | 1764 Silver Bell Rd, Eagan, MN 55122 | 2019-01-02 |
| 1194213280 | Amherst H. Wilder Foundation | Lodging | Lincoln Place, 1997 Gold Trail, Eagan, MN 55122 | 2018-04-25 |
| 1831541168 | Mackenzie Lea Kerber | Counselor | 3410 Federal Dr Suite 101, Eagan, MN 55122 | 2016-07-11 |
| 1285010074 | Eagan Pointe Senior Living | Assisted Living Facility | 4232 Black Hawk Road, Eagan, MN 55122 | 2015-08-04 |
| 1700268828 | Kara Beth Rose | Specialist/Technologist | 4560 Cinnamon Ridge Trail, Eagan, MN 55122 | 2015-06-25 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| 1528451028 | Judi Ross Holistic Therapy, LLC | Marriage & Family Therapist | 4141 Old Sibley Memorial Highway, Eagan, MN 55122 | 2015-03-09 |
| 1447649637 | Leah Ruth Streitman | Physician Assistant | 3460 Washington Dr Ste 200, Eagan, MN 55122 | 2015-01-12 |
| 1518362193 | Cedar Valley Center for Child & Family Therapy | Preferred Provider Organization | 3460 Washington Dr., Suite 110, Eagan, MN 55122 | 2014-10-25 |
| 1316351703 | Wecare Dental of Eagan P.c | Clinic/Center | 1625 Lena Court Suite 100, Eagan, MN 55122 | 2014-06-13 |
| Find all providers in zip 55122 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205443850 | Birchwood Dental, LLC | Dentist | 3356 Sherman Crt Ste 101, Eagan, MN 55121 | 2020-09-28 |
| 1730734708 | Ideal Dental Pllc | Dentist | 2130 Cliff Rd Ste 107, Eagan, MN 55122-2486 | 2019-08-07 |
| 1760972749 | Nicholas Theodore Schulte | Dentist | 1960 Cliff Lake Rd Ste 127, Eagan, MN 55122-2439 | 2018-05-15 |
| 1184093551 | Eagan Smiles Dentistry, PC | Dentist | 3405 Promenade Ave, Suite 300, Eagan, MN 55123-4404 | 2015-09-16 |
| 1225265309 | Molly Anne Henry | Dentist | 1965 Cliff Lake Rd, Suite #102, Eagan, MN 55122-2590 | 2009-06-16 |
| 1144353780 | Eagan Family Dentistry | Dentist | 4178 Knob Dr Ste C, Eagan, MN 55122-1875 | 2007-03-13 |
| 1871632026 | Karrie Marie Glasgow | Dentist | 1260 Yankee Doodle Rd, Suite 102, Eagan, MN 55121-2201 | 2007-02-05 |
| 1528127917 | Mark Joseph Skala | Dentist | 1905 Plaza Dr, Eagan, MN 55122-2883 | 2006-12-08 |
| 1841368545 | Dr Gerald W Rauchwarter Dds LLC | Dentist | 1960 Cliff Lake Road, #127, Eagan, MN 55122 | 2006-12-01 |
| 1932275971 | Pdg, P.a. | Dentist | 1895 Plaza Dr, Suite 130, Eagan, MN 55122-4600 | 2006-11-28 |
| Find all providers in EAGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.