| Maple Grove Periodontics And Implant Dentistry | |
|
12000 Elm Creek Blvd N Maple Grove MN 55369-7073 | |
| (763) 420-0200 | |
| Not Available |
| Full Name | Maple Grove Periodontics And Implant Dentistry |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 12000 Elm Creek Blvd N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Jennifer C Sullivan (PERIODONTIST/OWNER) |
| Authorized Official Contact | 6468089088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Grove Periodontics And Implant Dentistry 12000 Elm Creek Blvd N Maple Grove MN 55369-7073 Ph: (646) 808-9088 | Maple Grove Periodontics And Implant Dentistry 12000 Elm Creek Blvd N Maple Grove MN 55369-7073 Ph: (763) 420-0200 |
| NPI Number | 1891295861 |
|---|---|
| Provider Enumeration Date | 02/16/2018 |
| Last Update Date | 02/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891295861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | S125 (Minnesota) | Primary |
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