Maple Grove Periodontics and Implant Dentistry
NPI #1891295861 in Maple Grove, Minnesota
Provider Information
- NPI Number
- 1891295861
- Entity Type
- Organization
- Organization Name
- Maple Grove Periodontics and Implant Dentistry
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Feb 16, 2018
- Last Updated
- Feb 16, 2018
Practice Location
- Address
- 12000 ELM CREEK BLVD N
- City
- Maple Grove
- State
- Minnesota
- ZIP Code
- 55369-7073
- Phone
- (763) 420-0200
Authorized Official
- Name
- JENNIFER C SULLIVAN, DDS, MSD
- Title
- PERIODONTIST/OWNER
- Phone
- (646) 808-9088
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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