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MINNEAPOLIS-ST. PAUL PERIODONTICS
NPI 1013216811
Dentist - Periodontics in Fridley, MN

Active since March 18, 2011
1109 EAST MOORE LAKE DRIVE, FRIDLEY, MN 55432(651) 439-2600(651) 439-2211 Get Directions Write a Review

NPPES record last updated: March 18, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Minneapolis-st. Paul Periodontics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MINNEAPOLIS-ST. PAUL PERIODONTICS (NPI 1013216811) is a healthcare organization registered as a periodontics in Fridley, Minnesota and active in the NPI registry since March 2011. The organization lists Doug S Wolff, Owner, as its authorized official.

NPPES Registry Identity

NPI1013216811
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameMINNEAPOLIS-ST. PAUL PERIODONTICS
Location Address1109 EAST MOORE LAKE DRIVEFridley, MN 55432
Mailing Address1109 East Moore Lake DriveFridley, MN 55432 · (651) 439-2600 · Fax (651) 439-2211
Phone(651) 439-2600
Fax(651) 439-2211
Organization SubpartYesParent: St. Croix Valley Dental
Authorized OfficialDoug S WolffOwner · (651) 439-2600
Enumeration DateMarch 18, 2011
✔ NPI 1013216811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in MN · D11710
Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

1109 EAST MOORE LAKE DRIVE, Fridley, MN 55432
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORTHERN ORTHODONTICS
Clinic/Center (Dental)
1109 EAST MOORE LAKE DRIVE
FRIDLEY, MN 55432
Anoka County (651) 439-2600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Minneapolis-St. Paul Periodontics's NPI number?

The NPI number for Minneapolis-St. Paul Periodontics is 1013216811. It was assigned to this organization in the NPPES registry on March 18, 2011.

Where is Minneapolis-St. Paul Periodontics located?

Minneapolis-St. Paul Periodontics is located at 1109 East Moore Lake Drive, Fridley, MN 55432. The listed phone number is (651) 439-2600.

What is Minneapolis-St. Paul Periodontics's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Minneapolis-St. Paul Periodontics was last updated on March 18, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.