NPI 1013216811

Minneapolis-St. Paul Periodontics

Organisation Periodontics Fridley, MN

Practice location

Address: 1109 East Moore Lake Drive, Fridley, MN 55432
Phone: (651) 439-2600
Fax: (651) 439-2211

Authorised official

Name: Doug S Wolff
Title: Owner
Phone: (651) 439-2600

Registered specialties

Periodontics Primary

Dental Providers Taxonomy 1223P0300X Licence D11710 (MN)

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Registry record

NPI: 1013216811
Entity type: Organization
NPI issued: 18 Mar 2011
Record last updated: 18 Mar 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.