Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Maple Grove Family Dental Clinic, PA

Organization General Practice Dentistry · NPI 1922181197

Maple Grove Family Dental Clinic, PA provides 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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