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General NPI Number Information
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NPI Number | 1427309707
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL LLC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 600 22ND AVE NW
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City | MINOT
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State | ND
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Zip | 58703-0986
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Country | US
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Telephone | 701-839-2372
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Fax |
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Provider Business Mailing Address
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Address Line | 600 22ND AVE NW
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City | MINOT
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State | ND
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Zip | 58703-0986
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Country | US
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Telephone | 701-839-2372
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTIAN D MELAND
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Credential | DDS
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Telephone | 701-839-2372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2128
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License Number State | ND
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