# GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Richard W Brunton PA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508058322
- **Authorized official:** MRS. CONNIE LOUISE MILLER (PRACTICE MANAGER)
- **Authorized official phone:** (651) 351-1010

## Contact information

- **Practice address:** 2850 CURVE CREST BLVD, SUITE 130, STILLWATER, MN 55082
- **Practice address phone:** (651) 351-1010
- **Practice address fax:** (651) 351-9333
- **Mailing address:** 2850 CURVE CREST BLVD, SUITE 130, STILLWATER, MN 55082
- **Mailing address phone:** (651) 351-1010
- **Mailing address fax:** (651) 351-9333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 10762 | MN | Yes |

## Other

- **Enumeration date:** 08/15/2007
- **Last updated:** 10/20/2010