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Organization
GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization
GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Other names
Richard W Brunton PA
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE LOUISE MILLER (PRACTICE MANAGER)
(651) 351-1010
Entity
Organization
Contact information
Practice address
2850 CURVE CREST BLVD, SUITE 130, STILLWATER, MN 55082
(651) 351-1010
(651) 351-9333
Mailing address
2850 CURVE CREST BLVD, SUITE 130, STILLWATER, MN 55082
(651) 351-1010
(651) 351-9333
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10762
MN
Other
Enumeration date
08/15/2007
Last updated
10/20/2010
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