Individual
MRS. STACIE LEE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
501 WEST COLLEGE DRIVE, BRAINERD, MN 56401
(218) 855-8272
(218) 855-8270
Mailing address
501 WEST COLLEGE DRIVE, BRAINERD, MN 56401
(218) 855-8272
(218) 855-8270
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H7554
MN
Other
Enumeration date
01/04/2010
Last updated
01/04/2010
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