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Contact Information

LAND OF LAKES ENDODONTICS PA
2850 CURVE CREST BLVD W STE 115
STILLWATER, MN55082-6101
 Phone: 651-439-8764
 Fax: 651-439-9660
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for LAND OF LAKES ENDODONTICS PA

NPI Number 1710108022
LBN Legal business name LAND OF LAKES ENDODONTICS PA
Authorized official MATTHEW GRAU - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/02/2007
Last updated 02/16/2016 - About 10 years ago
Identifiers
MN License # 11312
MN Other 237L1LA BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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