Provider Demographics
NPI:1760272611
Name:DENTAL DELIVERY SYSTEMS OF MAPLE GROVE LLC
Entity type:Organization
Organization Name:DENTAL DELIVERY SYSTEMS OF MAPLE GROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-224-7233
Mailing Address - Street 1:13899 HIGHWAY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2135
Mailing Address - Country:US
Mailing Address - Phone:952-440-2292
Mailing Address - Fax:
Practice Address - Street 1:9400 UPLAND LANE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-363-0063
Practice Address - Fax:763-363-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty