| Coon Rapids Modern Dentistry | |
|
3320 124th Ave Nw Coon Rapids MN 55433-1001 | |
| (763) 290-6623 | |
| Not Available |
| Full Name | Coon Rapids Modern Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 3320 124th Ave Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Parvathi Jithendranathan (OWNER) |
| Authorized Official Contact | 7632906623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coon Rapids Modern Dentistry Po Box 920050 Dallas TX 75392-0050 | Coon Rapids Modern Dentistry 3320 124th Ave Nw Coon Rapids MN 55433-1001 Ph: (763) 290-6623 |
| NPI Number | 1295431138 |
|---|---|
| Provider Enumeration Date | 02/02/2023 |
| Last Update Date | 02/02/2023 |
| Certification Date | 02/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295431138 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (NU) | Primary |
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