NPI: 1710684196 · MAPLE GROVE, MN 55369 · Dental Clinic/Center · NPI assigned 02/15/2023
| Authorized Official | HOLMGREN, JANNA (DENTIST) |
| NPI Enumeration Date | 02/15/2023 |
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 13 | $380.21 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $380.21 |