MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY (NPI# 1891295861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891295861 |
| Entity Type | Organization |
| Organization Name | MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY |
| Practice Address |
12000 Elm Creek Blvd N Maple Grove MN 55369-7073 |
| Practice Telephone | 7634200200 |
| Mailing Telephone | 6468089088 |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |
| Authorized Official Name | JENNIFER C SULLIVAN (PERIODONTIST/OWNER) |
| Authorized Official Telephone | 6468089088 |
| Authorized Official Credential | DDS, MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
S125 | MN | Dental Providers |
| Street Address |
12000 ELM CREEK BLVD N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-7073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710979489 | Christopher A. Carlson | Family Medicine | 12000 Elm Creek Blvd N, Suite 130, Maple Grove, MN 55369-7073 | 2005-08-18 |
| 1598111684 | Michael Lao | Counselor | 12000 Elm Creek Blvd N, L70, Maple Grove, MN 55369-7073 | 2016-05-09 |
| 1629410618 | Kimberly Anne Gustafson | Physical Therapist | 12000 Elm Creek Blvd N, Suite #120, Maple Grove, MN 55369-7073 | 2013-07-19 |
| 1487997037 | Kyrsten Ann Johnson | Pediatrics | 12000 Elm Creek Blvd N, Suite 250, Maple Grove, MN 55369-7073 | 2013-04-02 |
| 1851662688 | Lee Medical Inc | Durable Medical Equipment & Medical Supplies | 12000 Elm Creek Blvd N, Suite 360, Maple Grove, MN 55369-7073 | 2012-01-25 |
| 1841523248 | Mcrh Alpha Medical, P.a. | Obstetrics & Gynecology | 12000 Elm Creek Blvd N, Suite 350, Maple Grove, MN 55369-7073 | 2009-09-16 |
| 1396976437 | Great Planes Reproductive Center, P.a. | Obstetrics & Gynecology | 12000 Elm Creek Blvd N, Suite 350, Maple Grove, MN 55369-7073 | 2009-08-06 |
| 1649401688 | The Midwest C Enter for Reproductive Heatlh, P.a. | Obstetrics & Gynecology | 12000 Elm Creek Blvd N, Suite 350, Maple Grove, MN 55369-7073 | 2009-08-06 |
| 1184889073 | Jamie L Sledd | Clinic/Center | 12000 Elm Creek Blvd N, Suite 230, Maple Grove, MN 55369-7073 | 2008-07-21 |
| 1417123696 | Anshu Sharma | Family Medicine | 12000 Elm Creek Blvd N, Suite 130, Maple Grove, MN 55369-7073 | 2008-05-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720252349 | Leilani L Labelle | Dentist | 12000 Elm Creek Blvd, #320, Maple Grove, MN 55369 | 2008-04-15 |
| 1457374779 | Ivan P Streif | Dentist | 13998 Maple Knoll Way, Maple Grove, MN 55369-7004 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316400591 | Shorouk Elnagdy | Dentist | 515 Delaware St Se # 7-368, Minneapolis, MN 55455-0357 | 2019-04-13 |
| 1508300252 | Minnesota Periodontal Associates, Pa | Dentist | 4801 Hwy 61 N., Suite 300, White Bear Lake, MN 55110-2753 | 2016-12-15 |
| 1164978672 | Benjamin Halpern | Dentist | 14344 Burnhaven Drive, Burnsville, MN 55306 | 2016-08-26 |
| 1356684419 | Shahir Nehad Abdel-malek | Dentist | 3555 Louisiana Ave S, Saint Louis Park, MN 55426-4121 | 2013-03-27 |
| 1386901858 | Jeanne L Barss | Dentist | 2550 University Ave W Ste 189s, Saint Paul, MN 55114-2001 | 2012-04-20 |
| 1205129012 | Jerod Thomas Klava | Dentist | 6545 France Ave. So., Suite 190, Edina, MN 55435 | 2011-05-26 |
| 1861784050 | Elham Akhlaghi | Dentist | 515 Delaware Street, Minneapolis, MN 55455 | 2011-05-06 |
| 1013216811 | Minneapolis-st. Paul Periodontics | Dentist | 1109 East Moore Lake Drive, Fridley, MN 55432 | 2011-03-18 |
| 1558516369 | Mdo Periodontics Pa | Dentist | 1900 Kruchten Ct S, Ste. 101, Sartell, MN 56377-4730 | 2008-11-20 |
| 1972770006 | Ying-lien Wu | Dentist | 150 S 5th St Ste 1475, Minneapolis, MN 55402-4212 | 2008-05-08 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.