EAGLE LAKE FAMILY DENTISTRY, P.A. (NPI# 1528138948) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528138948 |
| Entity Type | Organization |
| Organization Name | EAGLE LAKE FAMILY DENTISTRY, P.A. |
| Practice Address |
104 Plainview Street Box 97 Eagle Lake MN 56024 |
| Practice Telephone | 5072573800 |
| Practice Fax Number | 5072573456 |
| Mailing Telephone | 5072573800 |
| Mailing Fax Number | 5072573456 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2016-02-09 |
| Authorized Official Name | DR. BRADLEY ALLAN HOLMBERG (PRESIDENT) |
| Authorized Official Telephone | 5072573800 |
| Authorized Official Credential | BS, DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
MN | Dental Providers |
| Street Address |
104 PLAINVIEW STREET BOX 97 |
| City | EAGLE LAKE |
| State | MN |
| Zip Code | 56024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770653446 | Bradley Allan Holmberg | Dentist | 104 Plainview Street, Eagle Lake, MN 56024 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396865614 | Terese M Olson | Chiropractor | 213 Parkway, Eagle Lake, MN 56024-0018 | 2007-03-30 |
| 1932220548 | Terry L Olson | Chiropractor | 213 Parkway, Eagle Lake, MN 56024-0018 | 2007-04-02 |
| 1376940171 | Abdulahi Osman | Contractor | 248 Oak Dr, Eagle Lake, MN 56024-3404 | 2014-11-24 |
| 1225427180 | Heartland Service Group | Secured Medical Transport (VAN) | 248 Oak Dr, Eagle Lake, MN 56024-3404 | 2015-01-15 |
| 1295060077 | Southern Minn. Homecare LLC | Home Health | 213 Parkway Ave, Eagle Lake, MN 56024-7709 | 2009-10-12 |
| 1306259056 | Southern Minnesota Home Care | Point of Service | 213 Parkway Ave, Eagle Lake, MN 56024-7709 | 2014-06-10 |
| 1871883173 | Anthony M Mcgowan | Chiropractor | 213 Parkway Ave, Eagle Lake, MN 56024-7709 | 2011-04-08 |
| 1245529650 | Andrew Vostad | Student in an Organized Health Care Education/Training Program | 104 Plainview Ave, Eagle Lake, MN 56024-7713 | 2011-04-06 |
| 1619362167 | Elena Marie Hernandez-lee | Registered Nurse | 409 Linda Dr, Eagle Lake, MN 56024-9618 | 2015-04-01 |
| 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 |
|---|---|---|---|---|
| 1770653446 | Bradley Allan Holmberg | Dentist | 104 Plainview Street, Eagle Lake, MN 56024 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962001149 | Kalyan Chakravarthy Kondreddi | Dentist | 327 Western Ave Ste A, Fergus Falls, MN 56537-2403 | 2020-10-20 |
| 1821696022 | Wyoming Family Dental | Dentist | 5378 East Viking Blvd., Wyoming, MN 55092 | 2020-10-12 |
| 1770190951 | Bluff Creek Dental Pllc | Dentist | 600 Market St Ste 130, Chanhassen, MN 55317-4570 | 2020-09-30 |
| 1205443850 | Birchwood Dental, LLC | Dentist | 3356 Sherman Crt Ste 101, Eagan, MN 55121 | 2020-09-28 |
| 1073128153 | Michael W Flinn Dds, Pa | Dentist | 200 Firewood Drive, Redwood, MN 56283 | 2020-09-15 |
| 1770196891 | Thomas J Hoeffel Dds Pa | Dentist | 2819 Hamline Ave N Ste 104, Roseville, MN 55113-7718 | 2020-08-28 |
| 1073123030 | True North Community Dental Clinic, LLC | Dentist | 415 East First Avenue, Shakopee, MN 55379 | 2020-08-05 |
| 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 |
| 1386252344 | Kacie Crowell Green | Dentist | 8900 Walnut St # 459, Rockford, MN 55373-5135 | 2020-07-16 |
| Find all providers with the same taxonomy | ||||
| City | EAGLE LAKE |
| Zip Code | 56024 |
Please comment or provide details below to improve the information on EAGLE LAKE FAMILY DENTISTRY, P.A..
| 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.