Provider Demographics
NPI:1902614167
Name:MAPLE BROOK DENTAL CENTER OF MN LTD
Entity type:Organization
Organization Name:MAPLE BROOK DENTAL CENTER OF MN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-742-2773
Mailing Address - Street 1:8401 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2266
Mailing Address - Country:US
Mailing Address - Phone:763-424-5313
Mailing Address - Fax:763-424-4503
Practice Address - Street 1:8401 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2266
Practice Address - Country:US
Practice Address - Phone:763-424-5313
Practice Address - Fax:763-424-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental