Organization
MAPLEWOOD ORAL AND MAXILLOFACIAL SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHALL L WADE DDS (VICE PRESIDENT)
(651) 578-7000
Entity
Organization
Contact information
Practice address
9950 VALLEY CREEK RD STE 100, WOODBURY, MN 55125-5803
(651) 578-7000
(651) 578-0157
Mailing address
9950 VALLEY CREEK RD STE 100, WOODBURY, MN 55125-5803
(651) 578-7000
(651) 578-0157
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52597OR
BLUE CROSS/BLUE SHIELD
MN
01
—
CP5308
RAILROAD MEDICARE
MN
Enumeration date
11/01/2006
Last updated
11/30/2007
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