# MAPLEWOOD ORAL AND MAXILLOFACIAL SURGERY, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003993304
- **Authorized official:** DR. MARSHALL L WADE DDS (VICE PRESIDENT)
- **Authorized official phone:** (651) 578-7000

## Contact information

- **Practice address:** 9950 VALLEY CREEK RD STE 100, WOODBURY, MN 55125-5803
- **Practice address phone:** (651) 578-7000
- **Practice address fax:** (651) 578-0157
- **Mailing address:** 9950 VALLEY CREEK RD STE 100, WOODBURY, MN 55125-5803
- **Mailing address phone:** (651) 578-7000
- **Mailing address fax:** (651) 578-0157

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 11/30/2007