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General NPI Number Information
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NPI Number | 1902614167
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Entity Type | Organization
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Legal Business Name | MAPLE BROOK DENTAL CENTER OF MN LTD
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 8401 W BROADWAY AVE
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2266
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Country | US
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Telephone | 763-424-5313
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Fax | 763-424-4503
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Provider Business Mailing Address
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Address Line | 8401 W BROADWAY AVE
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City | BROOKLYN PARK
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State | MN
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Zip | 55445-2266
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Country | US
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Telephone | 763-424-5313
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Fax | 763-424-4503
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Authorized Official
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Title or Position | OWNER DENTIST/PRESIDENT
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Name | DANH LAM
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Credential | DDS
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Telephone | 763-742-2773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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