Mahtomedi Dental P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

11396 Issued in MN

Legal business name

MAHTOMEDI DENTAL P.C.

Practice address

12425 55TH St N
Lake Elmo, MN 55042-7403

Phone

(651) 430-1020

Fax

(651) 439-2201

NPI assigned

Sep 23, 2013

Organization subpart

No

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

Authorized official

Name

Laurie L Stodola, DDSNPI 1831121045

Title

Owner/Dentist

Phone

(651) 430-1020

Specialties & licenses 1

Addresses

Other names 1

• Grace Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laurie Lee Stodola, D.D.S.

  • General Practice Dentistry
  • Lake Elmo, MN
  • NPI 1831121045
  NPD (past) Authorized official

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1275969263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 55TH ST N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550427403",
            "telephone_number": "651-430-1020",
            "fax_number": "651-439-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12425 55TH ST N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550427403",
            "telephone_number": "651-430-1020",
            "fax_number": "651-439-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHTOMEDI DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-23",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "STODOLA",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "651-430-1020",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "11396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elena Lozne, DDS
• Steven Lutz, PSY.D., LP
• LW Care LLC
• Alexander Maas
• Maryan Mahamoud
• Leslie Markowitz, PSYD, LP, BCBA
• Alissa C Maroney, DENTAL HYGIENIST
• Mark J Mayry, CRNA
• Sarah McCauley, LMFT
• Rebecca McCraw, MA, LPC

• Dentist in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.