GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.
NPI 1508058322
Dentist - Oral and Maxillofacial Surgery in Stillwater, MN

Q: What is Great Lakes Oral & Maxillofacial Surgery, P.A.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since August 15, 2007

2850 CURVE CREST BLVD, SUITE 130, STILLWATER, MN 55082(651) 351-1010(651) 351-9333 Get Directions Write a Review

NPPES record last updated: October 20, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Great Lakes Oral & Maxillofacial Surgery, P.a. NPPES

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

GREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A. (NPI 1508058322), doing business as Richard W Brunton Pa, is a healthcare organization registered as an oral and maxillofacial surgery in Stillwater, Minnesota and active in the NPI registry since August 2007. The organization lists Connie Louise Miller, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1508058322

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameGREAT LAKES ORAL & MAXILLOFACIAL SURGERY, P.A.

Location Address2850 CURVE CREST BLVD, SUITE 130Stillwater, MN 55082

Mailing Address2850 Curve Crest Blvd, Suite 130Stillwater, MN 55082 · (651) 351-1010 · Fax (651) 351-9333

Phone(651) 351-1010

Fax(651) 351-9333

Organization SubpartNo

Authorized OfficialConnie Louise MillerPractice Manager · (651) 351-1010

Enumeration DateAugust 15, 2007

Last NPPES UpdateOctober 20, 2010

✔ NPI 1508058322 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in MN · 10762

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

2850 CURVE CREST BLVD, Stillwater, MN 55082

Open in Google Maps ↗

Other Names 1

Former Legal Business NameRichard W Brunton Pa

Other Identifiers 5

Other33714200WI · Medical Assistance

MedicaidCC02769MN

Medicare PIN000079110WI

Other616822100MN · Medical Assistance

Other88A90BRMN · Blue Cross Blue Shield

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 Great Lakes Oral & Maxillofacial Surgery, P.A.'s NPI number?

The NPI number for Great Lakes Oral & Maxillofacial Surgery, P.A. is 1508058322. It was assigned to this organization in the NPPES registry on August 15, 2007. The provider was formerly known as Richard W Brunton PA.

Where is Great Lakes Oral & Maxillofacial Surgery, P.A. located?

Great Lakes Oral & Maxillofacial Surgery, P.A. is located at 2850 Curve Crest Blvd Suite 130, Stillwater, MN 55082. The listed phone number is (651) 351-1010.

What is Great Lakes Oral & Maxillofacial Surgery, P.A.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

When was this NPI record last updated?

The NPPES record for Great Lakes Oral & Maxillofacial Surgery, P.A. was last updated on October 20, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.