| Great Lakes Oral & Maxillofacial Surgery, P.a. | |
|
2850 Curve Crest Blvd Suite 130 Stillwater MN 55082 | |
| (651) 351-1010 | |
| (651) 351-9333 |
| Full Name | Great Lakes Oral & Maxillofacial Surgery, P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2850 Curve Crest Blvd, Stillwater, Minnesota |
| Authorized Official Name and Position | Connie Louise Miller (PRACTICE MANAGER) |
| Authorized Official Contact | 6513511010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Oral & Maxillofacial Surgery, P.a. 2850 Curve Crest Blvd Suite 130 Stillwater MN 55082 Ph: (651) 351-1010 | Great Lakes Oral & Maxillofacial Surgery, P.a. 2850 Curve Crest Blvd Suite 130 Stillwater MN 55082 Ph: (651) 351-1010 |
| NPI Number | 1508058322 |
|---|---|
| Provider Enumeration Date | 08/15/2007 |
| Last Update Date | 10/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508058322 | NPI | - | NPPES |
| 33714200 | Other | WI | MEDICAL ASSISTANCE |
| CC02769 | Medicaid | MN | |
| 616822100 | Other | MN | MEDICAL ASSISTANCE |
| 88A90BR | Other | MN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 10762 (Minnesota) | Primary |
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