Provider Demographics
NPI:1831121045
Name:STODOLA, LAURIE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:LEE
Last Name:STODOLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 55TH ST N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-7403
Mailing Address - Country:US
Mailing Address - Phone:651-430-1020
Mailing Address - Fax:651-439-2201
Practice Address - Street 1:12425 55TH ST N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-7403
Practice Address - Country:US
Practice Address - Phone:651-430-1020
Practice Address - Fax:651-439-2201
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice