LAKE STREET DENTAL (NPI# 1184829509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184829509 |
| Entity Type | Organization |
| Organization Name | LAKE STREET DENTAL |
| Practice Address |
1508 E Lake St Minneapolis MN 55407-1720 |
| Practice Telephone | 6127241717 |
| Mailing Telephone | 6127241717 |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RENEE CAMARA GOOD (PERIOSONTIST) |
| Authorized Official Telephone | 6127241717 |
| Authorized Official Credential | D.D.S., M.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 1223G0001X |
Dentist Specialization: General Practice |
D11889 | MN | Dental Providers |
| X | 1223P0300X |
Dentist Specialization: Periodontics |
D11718 | MN | Dental Providers |
| X | 1223P0700X |
Dentist Specialization: Prosthodontics |
D12007 | MN | Dental Providers |
| Street Address |
1508 E LAKE ST |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55407-1720 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750774428 | Bucca Dental LLC | Clinic/Center | 1508 E Lake St, Minneapolis, MN 55407-1720 | 2015-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720644057 | Amana Home Care | Home Health | 2833 13th Ave S Suite 118, Minneapolis, MN 55407 | 2019-05-13 |
| 1356802979 | Aaron Randy Pickrel | Student in an Organized Health Care Education/Training Program | 2800 Chicago Avenue, #250, Minneapolis, MN 55407 | 2019-03-27 |
| 1053881631 | Naimo Abdisalam | Registered Nurse | 1229 East Lake Street, Minneapolis, MN 55407 | 2018-11-27 |
| 1437639614 | Kelly Usitalo | Nurse Practitioner | 913 E 26th Street, Piper Building Suite 401, Minneapolis, MN 55407 | 2018-08-17 |
| 1952880346 | Allison Hall | Internal Medicine | Minneapolis Heart Institute, 920 E 28 St. #300, Minneapolis, MN 55407 | 2018-08-07 |
| 1780176370 | Rebekah Sand | Physical Therapist | 2800 Chicage Avenue S, Suite 102, Minneapolis, MN 55407 | 2018-05-31 |
| 1417448663 | Vivian T.c. Liu | Student in an Organized Health Care Education/Training Program | 2020 E 28th Street, Suite 104, Minneapolis, MN 55407 | 2018-05-23 |
| 1053802397 | Isuroon | Counselor | 1600 East Lake Street Suite 1, Minneapolis, Mpls, MN 55407 | 2018-05-22 |
| 1154811404 | Mohamed Mukhtar Ali | Dentist | 4700 Cedar Ave S, Minneapolis, MN 55407 | 2018-05-12 |
| 1396254280 | Erin Elizabeth Casper | Registered Nurse | 3621 Oakland Ave, Minneapolis, MN 55407 | 2017-09-25 |
| Find all providers in zip 55407 | ||||
| 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 |
|---|---|---|---|---|
| 1679182687 | Downtown Dental Center Pllc | Dentist | 825 Nicollet Mall Ste 1427, Minneapolis, MN 55402-2703 | 2020-07-26 |
| 1205444791 | Patrick Reilly Steck | Dentist | 4948 S 34th Ave, Minneapolis, MN 55417 | 2020-07-21 |
| 1124684725 | Eric James Holthaus | Dentist | 825 Nicollet Ave #1025, Minneapolis, MN 55402 | 2019-05-20 |
| 1154811404 | Mohamed Mukhtar Ali | Dentist | 4700 Cedar Ave S, Minneapolis, MN 55407 | 2018-05-12 |
| 1154828283 | Ari Michael Lederman | Dentist | 825 Nicollet Mall Ste 425, Minneapolis, MN 55402-2608 | 2018-04-05 |
| 1730604877 | Daryl Grigsby Jr. | Dentist | 515 Delaware St Se # 8-166, Minneapolis, MN 55455-0357 | 2017-08-10 |
| 1033630371 | Margaret Elizabeth Craven | Dentist | 250 2nd Ave S Ste 250, Minneapolis, MN 55401-2173 | 2017-06-27 |
| 1013330661 | Helen Oboro-onuora | Dentist | 606 24th Ave S Suite 200, Umphysicians Dental Clinic, Minneapolis, MN 55454 | 2014-01-31 |
| 1548690001 | Patrick J. Foy Dds,pa | Dentist | 606 24th Ave S Ste 806, Minneapolis, MN 55454-1438 | 2013-11-20 |
| 1659719078 | Deanna Miller | Dentist | 3428 20th Ave S, Minneapolis, MN 55407-2408 | 2013-06-07 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55407 |
Please comment or provide details below to improve the information on LAKE STREET DENTAL.
| 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.