# NORTHLAND DENTAL PARTNERS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHLAND DENTAL PARTNERS, PLLC
- **Other names:** Metro Dentalcare Maple Grove Bass Lake
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1528716966
- **Legal business name:** NORTHLAND DENTAL PARTNERS, PLLC
- **Authorized official:** CELIA HAYES (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-2100

## Contact information

- **Practice address:** 13340 BASS LAKE RD, MAPLE GROVE, MN 55311-4540
- **Practice address phone:** (763) 478-9219
- **Practice address fax:** (763) 478-3961
- **Mailing address:** 13340 BASS LAKE RD, MAPLE GROVE, MN 55311-4540
- **Mailing address phone:** (763) 478-9219
- **Mailing address fax:** (763) 478-3961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2022
- **Last updated:** 03/15/2022