MAXILLOFACIAL IMAGING LLC (NPI# 1679732119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679732119 |
| Entity Type | Organization |
| Organization Name | MAXILLOFACIAL IMAGING LLC |
| Other Organization Name | ADVANCED HEAD & NECK IMAGING |
| Practice Address |
13998 Maple Knoll Way Maple Grove Professional Bld Suite Ll105 Maple Grove MN 55369-7004 |
| Practice Telephone | 7634200070 |
| Mailing Telephone | 7634200070 |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |
| Authorized Official Name | JANE ROACH (MANAGER) |
| Authorized Official Telephone | 7634200070 |
| Authorized Official Credential | RDH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Advanced Head & Neck Imaging | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477712008 | Maxillofacial Imaging LLC | Clinic/Center | 2860 Snelling Ave N, Suite 2, Roseville, MN 55113-1438 | 2008-06-09 |
| Street Address |
13998 MAPLE KNOLL WAY MAPLE GROVE PROFESSIONAL BLD SUITE LL105 |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-7004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760487359 | Venetia Laganis | Dentist | 13998 Maple Knoll Way, Ste 101, Maple Grove, MN 55369-7004 | 2005-06-20 |
| 1316361710 | Pipe Trade Healthcare Services | Clinic/Center | 13998 Maple Knoll Way, Maple Grove, MN 55369-7004 | 2014-02-06 |
| 1053609115 | Scott Kottemann | Dentist | 13998 Maple Knoll Way, Suite 102, Maple Grove, MN 55369-7004 | 2011-07-11 |
| 1558536151 | Venetia Laganis, Dds, Pa | Dentist | 13998 Maple Knoll Way, Suite 101, Maple Grove, MN 55369-7004 | 2008-04-24 |
| 1639244650 | Darrel Howard Johnsrud | Dentist | 13998 Maple Knoll Way, #100, Maple Grove, MN 55369-7004 | 2006-11-22 |
| 1265535868 | Kottemann Orthodontics Pa | Dentist | 13998 Maple Knoll Way, Suite 102, Maple Grove, MN 55369-7004 | 2006-09-07 |
| 1457374779 | Ivan P Streif | Dentist | 13998 Maple Knoll Way, Maple Grove, MN 55369-7004 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871006700 | Allina Health System | Clinic/Center | 3955 Parklawn Ave Ste 100, Edina, MN 55435-5660 | 2017-11-14 |
| 1740519933 | Mri School of Minnesota, LLC | Clinic/Center | 6053 Hudson Rd Ste 265, Woodbury, MN 55125-1000 | 2009-12-17 |
| 1093994030 | Children's Health Care | Clinic/Center | 2525 Chicago Ave. S., Minneapolis, MN 55404-4518 | 2007-10-26 |
| 1679601553 | Stand Up Mid America Mri, P.a. | Clinic/Center | 604 Lilac Dr N, Suite 100, Golden Valley, MN 55422-4610 | 2007-03-01 |
| 1184675670 | Cardiac Evaluation Services Inc | Clinic/Center | 8441 Wayzata Blvd, Golden Valley, MN 55426 | 2006-05-12 |
| 1629027594 | Suburban Radiologic Consultants, Ltd. | Clinic/Center | 2355 Hwy 36 W., Ste. 100, Roseville, MN 55113-5511 | 2006-05-09 |
| 1194725044 | Arrowhead Consultation Service Ltd | Clinic/Center | 415 Se 13th St, Suite 101, Grand Rapids, MN 55744-4248 | 2005-07-21 |
| 1396748307 | Lifescan Minnesota LLC | Clinic/Center | 3955 Parklawn Ave, Ste 110, Edina, MN 55435-5657 | 2005-05-23 |
| 1639648348 | St Joseph's Medical Center | Clinic/Center | 2019 S 6th St, Brainerd, MN 56401-4528 | 2018-11-26 |
| 1154834091 | Noble Imaging Center, LLC | Clinic/Center | 4610 Oak Grove Pkwy N, Brooklyn Park, MN 55443-4062 | 2017-11-14 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.