Gracie Isabella Comeau

Primary specialty

Dental TherapistTaxonomy code 125J00000X

License

DT164 Issued in MN

Practice address

2258 Bunker Lake Blvd NW
Andover, MN 55304-3900

Phone

(793) 390-8995

NPI assigned

Mar 7, 2023

Last updated

Jun 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1114627205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518 CEDAR LAKE RD S APT 6",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554163750",
            "telephone_number": "715-751-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2258 BUNKER LAKE BLVD NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043900",
            "telephone_number": "793-390-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMEAU",
        "first_name": "GRACIE",
        "middle_name": "ISABELLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MN",
            "license": "H11422",
            "primary": false
        },
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Collins
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Community Services of Minnesota Inc
• Kristin Lynn Connell, OTR/L
• Conscious Healing Counseling Inc
• Melissa Kay Craig, M.D.
• Courtney Erin Crawford, PHARMD

• Dental Therapist in Andover, MN
• Providers in Andover, MN by specialty
• Dental Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.