Provider Demographics
NPI:1467400515
Name:GRAU, MATTHEW M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:GRAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2850 CURVE CREST W BLVD 115
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4073
Mailing Address - Country:US
Mailing Address - Phone:651-439-8764
Mailing Address - Fax:651-439-9660
Practice Address - Street 1:2850 CURVE CREST BLVD W STE 115
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4073
Practice Address - Country:US
Practice Address - Phone:651-439-8764
Practice Address - Fax:651-439-9660
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN237L1LAOther1
MN6806273Medicaid