NPIMap

Organization Active NPI

Wang Periodontics PLLC

Doing business as Maple Grove Periodontics and Implant Dentistry

  • Periodontics
  • Maple Grove, MN
National Provider Identifier
1093442048
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
WANG PERIODONTICS PLLC
Doing business as
Maple Grove Periodontics and Implant Dentistry
Practice address
12000 Elm Creek Blvd N Ste 320
Maple Grove, MN 55369-7076
Phone
(763) 420-0200
NPI assigned
Aug 1, 2022
Last updated
Sep 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Authorized official

Name
Dr. Yun Wang, DDS, MS, PH.DNPI 1124484969
Title
President
Phone
(517) 648-3576

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
Periodontics 1223P0300X NU Primary

Addresses

Primary practice location

12000 Elm Creek Blvd N Ste 320
Maple Grove, MN 55369-7076

Mailing address

18145 59TH Ave N
Plymouth, MN 55446-3936
Phone (517) 648-3576

Other names 1

  • Maple Grove Periodontics and Implant Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

12000 Elm Creek Blvd N
Ste 320
Maple Grove, MN 55369
Phone (763) 420-0200

12737 Elm Creek Blvd N
Ste 320
Maple Grove, MN 55369

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1093442048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18145 59TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463936",
            "telephone_number": "517-648-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N STE 320",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697076",
            "telephone_number": "763-420-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANG PERIODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "YUN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-648-3576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS, PH.D"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Grove Periodontics and Implant Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Grove Periodontics and Implant Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.