Healthcare Provider Details

I. General information

NPI: 1639020597
Provider Name (Legal Business Name): ELM CREEK DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870 MAIN ST N
MAPLE GROVE MN
55369-7055
US

IV. Provider business mailing address

7870 MAIN ST N
MAPLE GROVE MN
55369-7055
US

V. Phone/Fax

Practice location:
  • Phone: 763-416-0606
  • Fax: 763-416-9963
Mailing address:
  • Phone: 763-416-0606
  • Fax: 763-416-9963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD CARTER
Title or Position: DENTIST
Credential: DDS
Phone: 763-416-0606