NPIMap

Organization Active NPI

Family Periodontic Specialists, PLC

Doing business as Metro Dentalcare Specialty Center Maple Grove - Periodontics

  • Periodontics
  • Maple Grove, MN
National Provider Identifier
1487303889
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
FAMILY PERIODONTIC SPECIALISTS, PLC
Doing business as
Metro Dentalcare Specialty Center Maple Grove - Periodontics
Practice address
15785 95TH Ave N
Maple Grove, MN 55369-4404
Phone
(763) 233-4141
Fax
(763) 420-3158
NPI assigned
Mar 22, 2022
Last updated
Mar 22, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY PERIODONTIC SPECIALISTS, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X NU Primary

Addresses

Primary practice location

15785 95TH Ave N
Maple Grove, MN 55369-4404

Mailing address

15785 95TH Ave N
Maple Grove, MN 55369-4404
Phone (763) 233-4141

Other names 1

  • Metro Dentalcare Specialty Center Maple Grove - Periodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Periodontic Specialists PLC4 organizations share this tax ID, including this one
Part of
Family Periodontic Specialists PLC

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1487303889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15785 95TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694404",
            "telephone_number": "763-233-4141",
            "fax_number": "763-420-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15785 95TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694404",
            "telephone_number": "763-233-4141",
            "fax_number": "763-420-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PERIODONTIC SPECIALISTS, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY PERIODONTIC SPECIALISTS, PLC",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Dentalcare Specialty Center Maple Grove - Periodontics",
            "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 Mar 22, 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.