Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Maple Grove Family Dental Clinic, PA

Organization General Practice Dentistry · NPI 1922181197

Maple Grove Family Dental Clinic, PA is a General Practice Dentistry in Maple Grove, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
Specialties on file
3
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12000 Elm Creek Blvd N Ste #220
Maple Grove, MN 55369-7073
Phone: (763) 420-4421
Fax: (763) 420-5674
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D11341 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence 9790 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence 10067 (MN)

Record details

NPI number1922181197
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Susan Larson — Clinic Administrator · (763) 420-4421
NPI enumeratedOctober 23, 2006
Last updated in NPPESAugust 22, 2020
Mailing address12000 Elm Creek Blvd N, Suite #220, Maple Grove, MN 55369-7073

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