| Maple Grove Family Dental Clinic, Pa | |
|
12000 Elm Creek Blvd N Suite #220 Maple Grove MN 55369-7073 | |
| (763) 420-4421 | |
| (763) 420-5674 |
| Full Name | Maple Grove Family Dental Clinic, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12000 Elm Creek Blvd N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Susan M. Larson (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 7634204421 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Grove Family Dental Clinic, Pa 12000 Elm Creek Blvd N Suite #220 Maple Grove MN 55369-7073 Ph: (763) 420-4421 | Maple Grove Family Dental Clinic, Pa 12000 Elm Creek Blvd N Suite #220 Maple Grove MN 55369-7073 Ph: (763) 420-4421 |
| NPI Number | 1922181197 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922181197 | NPI | - | NPPES |
| 10656 | Other | MN | BLUECROSSBLUE SHIELD |
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