INTERLACHEN DENTAL ASSOCIATES (NPI# 1174600621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174600621 |
| Entity Type | Organization |
| Organization Name | INTERLACHEN DENTAL ASSOCIATES |
| Practice Address |
5101 Vernon Avenue Suite 1b Edina MN 55436 |
| Practice Telephone | 9529209579 |
| Practice Fax Number | 9529209298 |
| Mailing Telephone | 9529209579 |
| Mailing Fax Number | 9529209298 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-01-12 |
| Authorized Official Name | DR. MICHAEL JOHN GITZEN (PRESIDENT OWNER DOCTOR) |
| Authorized Official Telephone | 9529209579 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
5101 VERNON AVENUE SUITE 1B |
| City | EDINA |
| State | MN |
| Zip Code | 55436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770534547 | Michael John Gitzen | Dentist | 5101 Vernon Avenue, Suite 1b, Edina, MN 55436 | 2006-05-15 |
| 1679689152 | Andres Humberto Rodriguez | Dentist | 5101 Vernon Avenue, Suite 1b, Edina, MN 55436 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326697277 | Nancy L. Dahlien | Technician | 5825 Tracy Avenue, Edina, MN 55436 | 2019-09-04 |
| 1194232033 | Kathryn Lagrave Reaney | Social Worker | 5050 Lincoln Dr Ste 350, Edina, MN 55436 | 2017-12-31 |
| 1417403296 | Lori Walker | Marriage & Family Therapist | 5780 Lincoln Drive, Suite 108, Edina, MN 55436 | 2016-08-31 |
| 1417374729 | Alisha Englund | Nurse Practitioner | 5901 Lincoln Drive, Cbc-ehs-2, Edina, MN 55436 | 2014-03-25 |
| 1669894887 | Orthodontic Care Specialists, Pllc | Dentist | 4980 W. 77th St., Edina, MN 55436 | 2014-01-07 |
| 1184976920 | Meisa Interpreting & Translation Services LLC. | Case Management | 5656 Lincoln Dr, Edina, MN 55436 | 2012-10-03 |
| 1730466996 | Gina Louise Smith Hughes | Dentist | 5101 Vernon Avenue South, Suite 1 B, Edina, MN 55436 | 2011-11-15 |
| 1669642864 | Diagnostic Imaging | Clinic/Center | 5021 Vernon Ave So, Suite 300, Edina, MN 55436 | 2008-03-04 |
| 1821266529 | Proreads | Clinic/Center | 5021 Vernon Ave S, Suite 300, Edina, MN 55436 | 2008-02-15 |
| 1386729978 | Rem Hennepin Inc | Intermediate Care Facility, Mentally Retarded | 5100 William Avenue, Edina, MN 55436 | 2006-10-25 |
| Find all providers in zip 55436 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811490527 | Allison Forbes | Dentist | 6516 W Shore Dr, Edina, MN 55435-1527 | 2018-03-09 |
| 1760837041 | Family and Cosmetic Gentle Dentistry | Dentist | 5107 Gus Young Ln, Edina, MN 55436-1530 | 2016-04-25 |
| 1174884753 | Russell N. Frys Jr,, Dds Pa | Dentist | 7550 France Ave South, Suite 138, Edina, MN 55435-4761 | 2012-05-31 |
| 1730466996 | Gina Louise Smith Hughes | Dentist | 5101 Vernon Avenue South, Suite 1 B, Edina, MN 55436 | 2011-11-15 |
| 1154568293 | Dulac Dental Ltd | Dentist | 6550 York Ave S Ste 202, Edina, MN 55435-2333 | 2009-01-12 |
| 1558525204 | Geeta Ramesh Sukhani | Dentist | 7300 France Ave S #110, Edina, MN 55435 | 2008-07-11 |
| 1780845073 | Joseph James Varno | Dentist | 5112 Duggan Plz, Edina, MN 55439-1453 | 2008-06-19 |
| 1407979511 | Tara Kaur | Dentist | 7701 York Ave South, Suite #140, Edina, MN 55435 | 2007-04-06 |
| 1184748634 | Carl E Schneider | Dentist | 3925 W 44th St, Edina, MN 55424-1032 | 2007-03-19 |
| 1346300217 | Sandra Rae Nelson | Dentist | 6545 France Ave S Ste 390, Edina, MN 55435-2121 | 2006-12-11 |
| Find all providers in EDINA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.