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2147 Northdale Blvd Nw Nwood Coon Rapids MN 55433-3006 | |
| (763) 767-4888 | |
| (763) 767-4889 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2147 Northdale Blvd Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Jeffrey W Moos (OWNER) |
| Authorized Official Contact | 7158292791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2147 Northdale Blvd Nw Nwood Coon Rapids MN 55433-3006 Ph: (763) 767-4888 | 2147 Northdale Blvd Nw Nwood Coon Rapids MN 55433-3006 Ph: (763) 767-4888 |
| NPI Number | 1003286808 |
|---|---|
| Provider Enumeration Date | 10/06/2015 |
| Last Update Date | 10/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003286808 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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