| NPI | 1164292256 |
|---|---|
| Doing Business As | MODERN SMILES |
| Entity Type | Organization |
| Authorized Contact | CHAD HENDRICKS Credentialing 612-859-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |