Family Periodontic Specialists, Plc
NPI #1487303889 in Maple Grove, Minnesota
Provider Information
- NPI Number
- 1487303889
- Entity Type
- Organization
- Organization Name
- Family Periodontic Specialists, Plc
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- FAMILY PERIODONTIC SPECIALISTS, PLC
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Mar 22, 2022
- Last Updated
- Mar 22, 2022
Practice Location
- Address
- 15785 95TH AVE N
- City
- Maple Grove
- State
- Minnesota
- ZIP Code
- 55369-4404
- Phone
- (763) 233-4141
Authorized Official
- Name
- CELIA HAYES
- Title
- CREDENTIALING COORDINATOR
- Phone
- (217) 540-2100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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