OrganizationActive
Minneapolis-St. Paul Periodontics
NPI 1013216811 · Periodontics · Fridley, MN
Provider details
- NPI number
- 1013216811
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Parent organization
- St. Croix Valley Dental
- Organization subpart
- Yes
- Authorized official
- Doug Wolff, Owner(651) 439-2600
- License
- D11710 (MN)
Specialties & taxonomies
Dental Providers
Practice location
1109 East Moore Lake Drive
Fridley, MN 55432
Phone: (651) 439-2600
Fax: (651) 439-2211
Approximate (ZIP-level) locationGet directions
Mailing address
1109 East Moore Lake Drive
Fridley, MN 55432
Registry dates
- Enumerated
- 2011-03-18
- Last updated
- 2011-03-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.