# MAPLE GROVE CENTER FOR RESTORATIVE SURGERY LLC

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

## Provider details

- **NPI number:** 1144644717
- **Authorized official:** DANIEL HANSON (MEDICAL DIRECTOR)
- **Authorized official phone:** (651) 324-8693

## Contact information

- **Practice address:** 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN 55369
- **Practice address phone:** (763) 432-7655
- **Practice address fax:** (763) 432-7501
- **Mailing address:** 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN 55369
- **Mailing address phone:** (763) 432-7655
- **Mailing address fax:** (763) 432-7501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 679516700023 | MN | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/18/2014
- **Last updated:** 12/19/2019