GREAT LAKES CHILDRENS DENTAL CARE PA (NPI# 1790795821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790795821 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES CHILDRENS DENTAL CARE PA |
| Practice Address |
2710 Piedmont Avenue Duluth MN 55811 |
| Practice Telephone | 2185255100 |
| Practice Fax Number | 2187223883 |
| Mailing Telephone | 2185255100 |
| Mailing Fax Number | 2187223883 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. RAMI M GUIRGUIS (OWNER) |
| Authorized Official Telephone | 2185255100 |
| Authorized Official Credential | DDS MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 1223D0001X |
Dentist Specialization: Dental Public Health |
D11559 | MN | Dental Providers |
| X | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
D10919 | MN | Dental Providers |
| Street Address |
2710 PIEDMONT AVENUE |
| City | DULUTH |
| State | MN |
| Zip Code | 55811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417515339 | Kyle Olson-merrick | Dentist | 320 W Myrtle St, Ste 100, Duluth, MN 55811 | 2019-06-05 |
| 1184288979 | Pdg, P.a. | Clinic/Center | 4891 Miller Truck Hwy., Suite 100, Hermantown, MN 55811 | 2019-04-26 |
| 1528589843 | Breanna Joy Greenly | Counselor | 4720 Burning Tree Road, Birch Tree Center, Duluth, MN 55811 | 2017-06-28 |
| 1396102398 | Debbie Christian | Registered Nurse | 4815 Burning Tree Rd Suite 100, Duluth, MN 55811 | 2016-01-21 |
| 1831556935 | Megan Marie Paris | Psychologist | 715 East Central Entrance, Duluth, MN 55811 | 2016-01-20 |
| 1740666908 | Angela Fedo | Physical Therapy Assistant | 2101 Trinity Rd, Duluth, MN 55811 | 2015-08-10 |
| 1649657479 | Kayla Stephenson | Specialist/Technologist | 5024 Morris Thomas Road, Hermantown, MN 55811 | 2015-04-30 |
| 1073918843 | Northern Lives Inc. | Assisted Living Facility | 4014 Trinity Road, Duluth, MN 55811 | 2014-10-23 |
| 1114326238 | Donald Hermanson | Specialist/Technologist | 801 Boulder Drive, Apt. 202, Duluth, MN 55811 | 2014-08-14 |
| 1679990857 | Jodie Little | Pharmacist | 801 W. Central Entrance, Shopko Pharmacy 2114, Duluth, MN 55811 | 2014-03-25 |
| Find all providers in zip 55811 | ||||
| Taxonomy Code | 1223D0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Dental Public Health |
| The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245396894 | Ken E Edwards IIi | Dentist | 3502 Satellite Blvd, Duluth, GA 30096 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076073 | Rae Ann Ann Swanson | Dentist | 755 Florida Ave S, Minneapolis, MN 55426-1784 | 2020-09-02 |
| 1083178149 | Lift Dental Pllc | Dentist | 124 2nd St S Ste 101, Stillwater, MN 55082-5179 | 2019-01-23 |
| 1669842662 | Children's Dental Services | Dentist | 229 W Lake St, Chisholm, MN 55719 | 2015-10-02 |
| 1407224827 | Children's Dental Services | Dentist | 325 N Sibley Ave, Litchfield, MN 55355-2150 | 2015-09-02 |
| 1194095778 | Matthew Allen Olson | Dentist | 715 11th St N Ste 106b, Moorhead, MN 56560-2000 | 2012-01-12 |
| 1801118039 | Omar Dyab Dds Pa | Dentist | 13590 Northdale Blvd, Suite 300, Rogers, MN 55374-2150 | 2010-02-15 |
| 1407973605 | Childrens Dental Services Inc | Dentist | 636 Broadway St. Ne, Minneapolis, MN 55413 | 2007-03-23 |
| 1437287679 | Mississippi Headwaters Area Dental Health Center, Inc. | Dentist | 616 America Ave Nw Ste 340, Attention Mary Marchell, Bemidji, MN 56601-3871 | 2007-03-01 |
| 1205991866 | Fergus Falls Dental Group | Dentist | 1121 Pebble Lake Rd, Fergus Falls, MN 56537 | 2006-12-26 |
| 1437238052 | Tracey Roseann Charles | Dentist | 9345 Calypso Trail Nw, Bemidji, MN 56601 | 2006-11-03 |
| Find all providers with the same taxonomy | ||||
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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.