OrganizationActive
Mahtomedi Dental P.C.
NPI 1275969263 · Dentist · Lake Elmo, MN
Provider details
- NPI number
- 1275969263
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Laurie Stodola, Owner/Dentist(651) 430-1020
- License
- 11396 (MN)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
12425 55th St N
Lake Elmo, MN 55042-7403
Phone: (651) 430-1020
Fax: (651) 439-2201
Street-level locationGet directions
Mailing address
12425 55th St N
Lake Elmo, MN 55042-7403
Other names (DBA / former)
- Doing business as
- Grace Dental
Registry dates
- Enumerated
- 2013-09-23
- Last updated
- 2013-09-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.