Pdb, Dds, Pa

Specialty details in registry · Maple Grove, MN

Call (763) 559-2082 Directions

At a glance

12736 Bass Lake Rd, Maple Grove, MN 55369-6307

NPPES record updated Oct 22, 2020. Public records can lag behind changes at a practice.

Before you call: a quick checklist

Are you accepting new patients?
Do you accept my specific insurance plan?
Do you provide the service I need at this address?
Do I need a referral, and what is the earliest appointment?

Insurance participation and appointment availability are not established by these public records.

Practice location

12736 Bass Lake Rd
Maple Grove, MN 55369-6307

Professional details: NPI, taxonomy & registry record

NPI1942809637

Call Directions

Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 261QD0000X
Enumeration date: Oct 22, 2020
Record updated: Oct 22, 2020

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

261QD0000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

12736 Bass Lake Rd
Maple Grove, MN 55369-6307

Phone: (763) 559-2082

Mailing address

1485 COUNTY ROAD 101 N

PLYMOUTH, MN 554473053

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

Report a directory issue