OrganizationActive
Great Lakes Oral & Maxillofacial Surgery, P.A.
NPI 1508058322 · Oral and Maxillofacial Surgery (Dentist) · Stillwater, MN
Provider details
- NPI number
- 1508058322
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Connie Miller, Practice Manager
- License
- 10762 (MN)
Practice location
2850 Curve Crest Blvd
Suite 130
Stillwater, MN 55082
Phone: (651) 351-1010
Fax: (651) 351-9333
Mailing address
2850 Curve Crest Blvd
Stillwater, MN 55082
Registry dates
- Enumerated
- 2007-08-15
- Last updated
- 2010-10-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.