Individual
GRACIE ISABELLA COMEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2258 BUNKER LAKE BLVD NW, ANDOVER, MN 55304-3900
(793) 390-8995
Mailing address
4518 CEDAR LAKE RD S APT 6, MINNEAPOLIS, MN 55416-3750
(715) 751-0299
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H11422
MN
125J00000X
Dental Therapist
Primary
DT164
MN
Other
Enumeration date
03/07/2023
Last updated
06/21/2023
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