Organization
MAPLE GROVE PERIODONTICS AND IMPLANT DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER C SULLIVAN DDS, MSD (PERIODONTIST/OWNER)
(646) 808-9088
Entity
Organization
Contact information
Practice address
12000 ELM CREEK BLVD N, MAPLE GROVE, MN 55369-7073
(763) 420-0200
Mailing address
12000 ELM CREEK BLVD N, MAPLE GROVE, MN 55369-7073
(646) 808-9088
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
S125
MN
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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