Land of Lakes Endodontics PA

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

11312 Issued in MN

Legal business name

LAND OF LAKES ENDODONTICS PA

Practice address

2850 Curve Crest Blvd W Ste 115
Stillwater, MN 55082-6101

Phone

(651) 439-8764

Fax

(651) 439-9660

NPI assigned

May 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Matthew M Grau, DDSNPI 1467400515

Title

Owner

Phone

(651) 439-8764

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Matthew M Grau, D.D.S.

  • Endodontics
  • Stillwater, MN
  • NPI 1467400515
  NPD (past) Authorized official

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1710108022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 CURVE CREST BLVD W STE 115",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550824073",
            "telephone_number": "651-439-8764",
            "fax_number": "651-439-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 CURVE CREST BLVD W STE 115",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826101",
            "telephone_number": "651-439-8764",
            "fax_number": "651-439-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAND OF LAKES ENDODONTICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "GRAU",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-439-8764",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "11312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "237L1LA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeview Memorial Hospital Association Inc
• Lakeview Memorial Hospital Association Inc
• Lakeview Memorial Hospital Association Inc.
• Lakeview Memorial Hospital Association, Inc.
• Melissa Lam
• Jennifer Lynn Landers, MD
• Stephen S Lane, M.D.
• Jacob R Lang, O.D.
• Dennis Lanoux
• Blake Jonathon Lapoint

• Endodontics in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Endodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.