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Maple Grove Periodontics and Implant Dentistry

Periodontics practice in Maple Grove, MN

Registered specialistLicense # listed (MN)

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Public-record details

Address
12000 Elm Creek Blvd N, Maple Grove, MN 55369
Phone
(763) 420-0200
Listed under
Periodontists, Specialty practices
NPI
1891295861
NPI status
Active in the NPPES registry
Provider type
Organization (practice, clinic or company)
Registered specialty (self-reported taxonomy)
Periodontics (1223P0300X)
License number on NPI record
S125 (MN)
Authorized official
Jennifer Sullivan, DDS, MSD, Periodontist/owner
NPI first issued
Feb 16, 2018
NPI record last updated
Feb 16, 2018

NPI 1891295861 is active in the federal NPPES registry (CMS) with Periodontics, an ADA-recognized dental specialty, as its primary taxonomy; license S125 (MN) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an organization, so it may cover several clinicians at this location. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Periodontists specialize in the gums and bone that support the teeth, including placing implants, gum and bone grafting, and treating gum disease. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.

View NPI 1891295861 in the official registry ↗

Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.

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