Healthcare Provider Details

I. General information

NPI: 1255184651
Provider Name (Legal Business Name): ANAS AKHRAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12737 ELM CREEK BLVD N
MAPLE GROVE MN
55369-7045
US

IV. Provider business mailing address

7141 FRANCE AVE S APT 406
EDINA MN
55435-4329
US

V. Phone/Fax

Practice location:
  • Phone: 763-218-7005
  • Fax:
Mailing address:
  • Phone: 773-516-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD15513
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: