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GRACIE ISABELLA COMEAU
NPI 1114627205
Dental Therapist in Andover, MN

Active since March 07, 2023
2258 BUNKER LAKE BLVD NW, ANDOVER, MN 55304(793) 390-8995 Get Directions Write a Review

NPPES record last updated: June 21, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 21, 2023, Mar 7, 2023 (2 updates tracked since 2023).

About Gracie Isabella Comeau NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRACIE ISABELLA COMEAU (NPI 1114627205) is an individual dental therapist in Andover, Minnesota, licensed in Minnesota (DT164) and active in the NPI registry since March 2023.

NPPES Registry Identity

NPI1114627205
Entity TypeIndividualFemale
Primary Taxonomy125J00000X
Provider Legal NameGRACIE ISABELLA COMEAU
Location Address2258 BUNKER LAKE BLVD NWAndover, MN 55304-3900
Mailing Address4518 Cedar Lake Rd S Apt 6Minneapolis, MN 55416-3750 · (715) 751-0299
Phone(793) 390-8995
Sole ProprietorNo
Enumeration DateMarch 7, 2023
Last NPPES UpdateJune 21, 20232 updates tracked since enumeration
NPPES CertifiedJune 21, 2023
✔ NPI 1114627205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDental TherapistDental Providers
Taxonomy Code125J00000X
License✔ Licensed in MN · DT164
Definition

A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations.

Also ListedDental HygienistTaxonomy 124Q00000X · License H11422 (MN)
2258 BUNKER LAKE BLVD NW, Andover, MN 55304
Open in Google Maps ↗

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CUSTOM SMILES DENTISTRY, PLLC
Clinic/Center (Dental)
2258 BUNKER LAKE BLVD NW
ANDOVER, MN 55304
Anoka County (763) 390-8995

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gracie Comeau's NPI number?

The NPI number for Gracie Comeau is 1114627205. It was assigned to this individual provider in the NPPES registry on March 7, 2023.

Where is Gracie Comeau located?

Gracie Comeau practices at 2258 Bunker Lake Blvd NW, Andover, MN 55304. The listed phone number is (793) 390-8995.

What is Gracie Comeau's specialty?

The primary specialty registered for this NPI is Dental Therapist with taxonomy code 125J00000X.

When was this NPI record last updated?

The NPPES record for Gracie Comeau was last updated on June 21, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.