# FAMILY ORAL SURGERY SPECIALISTS, PLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FAMILY ORAL SURGERY SPECIALISTS, PLC
- **Other names:** Metro Dentalcare Specialty Center Maple Grove - Oral Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497404818
- **Legal business name:** FAMILY ORAL SURGERY SPECIALISTS, PLC
- **Authorized official:** CELIA HAYES (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 15785 95TH AVE N, MAPLE GROVE, MN 55369-4404
- **Practice address phone:** (763) 233-4141
- **Practice address fax:** (763) 420-3158
- **Mailing address:** 15785 95TH AVE N, MAPLE GROVE, MN 55369-4404
- **Mailing address phone:** (763) 233-4141
- **Mailing address fax:** (763) 420-3158

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2022
- **Last updated:** 03/22/2022