Organization
FAMILY PERIODONTIC SPECIALISTS, PLC
Active
Parent organization
FAMILY PERIODONTIC SPECIALISTS, PLC
Other names
Metro Dentalcare Specialty Center Maple Grove - Periodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY PERIODONTIC SPECIALISTS, PLC
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
15785 95TH AVE N, MAPLE GROVE, MN 55369-4404
(763) 233-4141
(763) 420-3158
Mailing address
15785 95TH AVE N, MAPLE GROVE, MN 55369-4404
(763) 233-4141
(763) 420-3158
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
03/22/2022
Last updated
03/22/2022
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