Maple Grove Periodontics and Implant Dentistry

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

S125 Issued in MN

Legal business name

MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY

Practice address

12000 Elm Creek Blvd N
Maple Grove, MN 55369-7073

Phone

(763) 420-0200

NPI assigned

Feb 16, 2018

Last updated

Feb 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer C Sullivan, DDS, MSD

Title

Periodontist/Owner

Phone

(646) 808-9088

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518739200000",
    "number": "1891295861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697073",
            "telephone_number": "646-808-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 ELM CREEK BLVD N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697073",
            "telephone_number": "763-420-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-16",
        "last_updated": "2018-02-16",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PERIODONTIST/OWNER",
        "authorized_official_telephone_number": "646-808-9088",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "S125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maple Grove Dialysis LLC (Maple Grove Dialysis Unit)
• Maple Grove Eye Care, LLC
• Maple Grove Family Dental Clinic, PA
• Maple Grove Hospital Corporation
• Maple Grove Hospital Corporation (Maple Grove Overnight Discharge Pharmacy)
• Maple Grove Smiles Dentistry, PC (Maple Grove Smiles Dentistry)
• Maple Grove Therapy and Wellness
• Maple Grove Urgent Care
• Maple Grove Vision Clinic, P.a.
• Maravent Health LLC

• Periodontics in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2018; 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.