NPIMap

Organization Active NPI

Minnesota Dental Professionals, P.C.

  • General Practice Dentistry
  • Maple Grove, MN
National Provider Identifier
1376403113
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MINNESOTA DENTAL PROFESSIONALS, P.C.
Practice address
18820 70TH Way N
Maple Grove, MN 55311-3585
Phone
(612) 254-2730
NPI assigned
Nov 14, 2025
Organization subpart
Yes
Parent organization
MINNESOTA DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

18820 70TH Way N
Maple Grove, MN 55311-3585

Mailing address

18820 70TH Way N
Maple Grove, MN 55311-3585
Phone (612) 254-2730

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Dental Professionals PC23 organizations share this tax ID, including this one
Part of
Minnesota Dental Professionals PC

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

18820 70th Way N
Maple Grove, MN 55311
Phone (612) 254-2730

Practitioners & affiliated clinicians

Practitioners 1

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": "1763078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1376403113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18820 70TH WAY N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553113585",
            "telephone_number": "612-254-2730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18820 70TH WAY N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553113585",
            "telephone_number": "612-254-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2025-11-14",
        "last_updated": "2025-11-14",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Nov 14, 2025; 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.