MINNEAPOLIS-ST. PAUL PERIODONTICS (NPI# 1013216811) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013216811 |
| Entity Type | Organization |
| Organization Name | MINNEAPOLIS-ST. PAUL PERIODONTICS |
| Practice Address |
1109 East Moore Lake Drive Fridley MN 55432 |
| Practice Telephone | 6514392600 |
| Practice Fax Number | 6514392211 |
| Mailing Telephone | 6514392600 |
| Mailing Fax Number | 6514392211 |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2011-03-18 |
| Authorized Official Name | DR. DOUG S WOLFF (OWNER) |
| Authorized Official Telephone | 6514392600 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. CROIX VALLEY DENTAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D11710 | MN | Dental Providers |
| Street Address |
1109 EAST MOORE LAKE DRIVE |
| City | FRIDLEY |
| State | MN |
| Zip Code | 55432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659670362 | Northern Orthodontics | Dentist | 1109 East Moore Lake Drive, Fridley, MN 55432 | 2011-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791177 | Adelyn Ruth Kopp | Occupational Therapist | 500 Osborne Rd Ne Suite 365, Fridley, MN 55432 | 2019-07-11 |
| 1831665603 | White Smiles Family Dentistry Pllc | Dentist | 1611 County Hwy 10, Minneapolis, MN 55432 | 2018-10-19 |
| 1518402213 | Peaceful Adult Day Center LLC. | Home Health | 6267 University Ave Ne, Fridley, MN 55432 | 2017-01-04 |
| 1205383742 | Farhiya Mahamud Gelle I | Durable Medical Equipment & Medical Supplies | 6329 5th Street Ne Apt 8, Fridley, MN 55432 | 2016-09-01 |
| 1093163164 | Christiane Schwecke | Specialist/Technologist | 8290 University Ave N, Fridley, MN 55432 | 2016-05-31 |
| 1336551563 | Amy White Mountain | Massage Therapist | 1611 County Hwy 10 Ne, Spring Lake Park, MN 55432 | 2014-05-22 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1952648180 | John Franklyn Marshall | Family Medicine | 480 Osborne Road Ne, Suite 100, Fridley, MN 55432 | 2013-01-08 |
| 1558610519 | Novacare Outpatient Rehabilitation East Inc | Clinic/Center | 480 Osborne Road, Number 280, Fridley, MN 55432 | 2012-09-06 |
| 1336423391 | Christian Restoration Services | Counselor | 7157 Commerce Circle W, Fridley, MN 55432 | 2011-10-07 |
| Find all providers in zip 55432 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003245333 | Dental Specialists of Minnesota, Pllc | Dentist | 1109 Moore Lake Dr E, Fridley, MN 55432-5171 | 2013-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316400591 | Shorouk Elnagdy | Dentist | 515 Delaware St Se # 7-368, Minneapolis, MN 55455-0357 | 2019-04-13 |
| 1508300252 | Minnesota Periodontal Associates, Pa | Dentist | 4801 Hwy 61 N., Suite 300, White Bear Lake, MN 55110-2753 | 2016-12-15 |
| 1164978672 | Benjamin Halpern | Dentist | 14344 Burnhaven Drive, Burnsville, MN 55306 | 2016-08-26 |
| 1356684419 | Shahir Nehad Abdel-malek | Dentist | 3555 Louisiana Ave S, Saint Louis Park, MN 55426-4121 | 2013-03-27 |
| 1386901858 | Jeanne L Barss | Dentist | 2550 University Ave W Ste 189s, Saint Paul, MN 55114-2001 | 2012-04-20 |
| 1205129012 | Jerod Thomas Klava | Dentist | 6545 France Ave. So., Suite 190, Edina, MN 55435 | 2011-05-26 |
| 1861784050 | Elham Akhlaghi | Dentist | 515 Delaware Street, Minneapolis, MN 55455 | 2011-05-06 |
| 1558516369 | Mdo Periodontics Pa | Dentist | 1900 Kruchten Ct S, Ste. 101, Sartell, MN 56377-4730 | 2008-11-20 |
| 1972770006 | Ying-lien Wu | Dentist | 150 S 5th St Ste 1475, Minneapolis, MN 55402-4212 | 2008-05-08 |
| 1760657795 | Steven Robert Jacobsen | Dentist | 4801 Hwy 61, #300, White Bear Lake, MN 55110 | 2008-04-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.