NPIMap

Organization Active NPI

Maplewood Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
National Provider Identifier
1003993304
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
MAPLEWOOD ORAL AND MAXILLOFACIAL SURGERY, P.A.
Practice address
9950 Valley Creek Rd Ste 100
Woodbury, MN 55125-5803
Phone
(651) 578-7000
Fax
(651) 578-0157
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marshall L Wade, DDSNPI 1386606937
Title
Vice President
Phone
(651) 578-7000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

9950 Valley Creek Rd Ste 100
Woodbury, MN 55125-5803

Mailing address

9950 Valley Creek Rd Ste 100
Woodbury, MN 55125-5803
Phone (651) 578-7000

Other identifiers 2

IdentifierTypeStateIssuer
52597OROtherMNBLUE CROSS/BLUE SHIELD
CP5308OtherMNRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

20 Lake St N
Ste 201
Forest Lake, MN 55025
Phone (651) 461-1799

1560 Beam Ave
Ste E
Maplewood, MN 55109
Phone (651) 578-7000

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1003993304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9950 VALLEY CREEK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255803",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9950 VALLEY CREEK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255803",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLEWOOD ORAL AND MAXILLOFACIAL SURGERY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "651-578-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "52597OR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP5308",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.