OrganizationActive
Maple Grove Periodontics and Implant Dentistry
NPI 1891295861 · Periodontics · Maple Grove, MN
Provider details
- NPI number
- 1891295861
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Jennifer Sullivan, Periodontist/Owner(646) 808-9088
- License
- S125 (MN)
Specialties & taxonomies
Dental Providers
Practice location
12000 Elm Creek Blvd N
Maple Grove, MN 55369-7073
Phone: (763) 420-0200
Approximate (ZIP-level) locationGet directions
Mailing address
12000 Elm Creek Blvd N
Maple Grove, MN 55369-7073
Registry dates
- Enumerated
- 2018-02-16
- Last updated
- 2018-02-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.