Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Great Lakes Oral & Maxillofacial Surgery, PA

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1508058322

Great Lakes Oral & Maxillofacial Surgery, PA is an Oral and Maxillofacial Surgery (Dentist) in Stillwater, Minnesota. Licensed in Minnesota. Registered with an NPI since 2007.

Licensed in
MN
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2850 Curve Crest Blvd Ste 130
Stillwater, MN 55082
Phone: (651) 351-1010
Fax: (651) 351-9333
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 10762 (MN)

Record details

NPI number1508058322
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Connie Miller — Practice Manager · (651) 351-1010
Other names Richard W Brunton Pa
NPI enumeratedAugust 15, 2007
Last updated in NPPESOctober 20, 2010
Mailing address2850 Curve Crest Blvd, Suite 130, Stillwater, MN 55082

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