| Grace Dental | |
|
12425 55th St N Lake Elmo MN 55042-7403 | |
| (651) 430-1020 | |
| (651) 439-2201 |
| Full Name | Grace Dental |
|---|---|
| Speciality | Dentist |
| Location | 12425 55th St N, Lake Elmo, Minnesota |
| Authorized Official Name and Position | Laurie L Stodola (OWNER/DENTIST) |
| Authorized Official Contact | 6514301020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Dental 12425 55th St N Lake Elmo MN 55042-7403 Ph: (651) 430-1020 | Grace Dental 12425 55th St N Lake Elmo MN 55042-7403 Ph: (651) 430-1020 |
| NPI Number | 1275969263 |
|---|---|
| Provider Enumeration Date | 09/23/2013 |
| Last Update Date | 09/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275969263 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 11396 (Minnesota) | Primary |
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