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Organization

LAND OF LAKES ENDODONTICS PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MATTHEW M GRAU DDS (OWNER)
(651) 439-8764
Entity
Organization

Contact information

Practice address
2850 CURVE CREST BLVD W STE 115, STILLWATER, MN 55082-6101
(651) 439-8764
(651) 439-9660
Mailing address
2850 CURVE CREST BLVD W STE 115, STILLWATER, MN 55082-4073
(651) 439-8764
(651) 439-9660

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
11312
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
237L1LA
BCBS
MN
Enumeration date
05/02/2007
Last updated
02/16/2016
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