Organization
MAHTOMEDI DENTAL P.C.
Active
Other names
Grace Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE L STODOLA DDS (OWNER/DENTIST)
(651) 430-1020
Entity
Organization
Contact information
Practice address
12425 55TH ST N, LAKE ELMO, MN 55042-7403
(651) 430-1020
(651) 439-2201
Mailing address
12425 55TH ST N, LAKE ELMO, MN 55042-7403
(651) 430-1020
(651) 439-2201
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11396
MN
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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