Healthcare Provider Details

I. General information

NPI: 1922947142
Provider Name (Legal Business Name): BLOOMINGTON SLEEP AND TMD CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 NICOLLET AVE S
MINNEAPOLIS MN
55420-4814
US

IV. Provider business mailing address

9820 NICOLLET AVE S
MINNEAPOLIS MN
55420-4814
US

V. Phone/Fax

Practice location:
  • Phone: 952-856-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRIAN GRAY
Title or Position: OWNER
Credential: DDS
Phone: 612-501-6738