| Family Periodontic Specialists, Plc | |
|
15785 95th Ave N Maple Grove MN 55369-4404 | |
| (763) 233-4141 | |
| (763) 420-3158 |
| Full Name | Family Periodontic Specialists, Plc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 15785 95th Ave N, Maple Grove, Minnesota |
| Authorized Official Name and Position | Celia Hayes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Periodontic Specialists, Plc 15785 95th Ave N Maple Grove MN 55369-4404 Ph: (763) 233-4141 | Family Periodontic Specialists, Plc 15785 95th Ave N Maple Grove MN 55369-4404 Ph: (763) 233-4141 |
| NPI Number | 1487303889 |
|---|---|
| Provider Enumeration Date | 03/22/2022 |
| Last Update Date | 03/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487303889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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