BIRCH LAKE DENTAL (NPI# 1922619162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922619162 |
| Entity Type | Organization |
| Organization Name | BIRCH LAKE DENTAL |
| Practice Address |
4641 White Bear Pkwy White Bear Lake MN 55110-3300 |
| Practice Telephone | 6514290404 |
| Mailing Telephone | 6514290404 |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |
| Authorized Official Name | DR. GEETHA J DAMODARAN (OWNER) |
| Authorized Official Telephone | 6514290404 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| BIRCH LAKE DENTAL | Doing Business As Name - Organization |
| Street Address |
4641 WHITE BEAR PKWY |
| City | WHITE BEAR LAKE |
| State | MN |
| Zip Code | 55110-3300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811212624 | David E Wolff | Dentist | 4641 White Bear Pkwy, White Bear Lake, MN 55110-3300 | 2010-04-05 |
| 1275858078 | Geetha J Damodaran | Dentist | 4641 White Bear Pkwy, White Bear Lake, MN 55110-3300 | 2010-04-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467071084 | St. Catherine University School Based Health Clinic | Nurse Practitioner | 5045 Division Ave, White Bear Lake, MN 55110 | 2020-04-14 |
| 1922450618 | Lisa Marie Thatcher | Podiatrist | 4653 White Bear Pkwy., St. Paul, MN 55110 | 2016-07-06 |
| 1558725598 | White Bear Dentists, PC | Dentist | 1970 Buerkle Road, White Bear Lake, MN 55110 | 2016-04-06 |
| 1124486246 | Julie Blaske | Counselor | 1310 Hwy 96 E, Suite 200, White Bear Lake, MN 55110 | 2016-02-03 |
| 1851761514 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 1920 Buerkle Rd, White Bear Lake, MN 55110 | 2015-10-06 |
| 1821496969 | Leah Eichmiller | Acupuncturist | 2183 3rd Street, C/o Indulge Salon, White Bear Lake, MN 55110 | 2014-12-05 |
| 1447672084 | Ashley Rath | Chiropractor | 1247 Gun Club Rd., White Bear Lake, MN 55110 | 2014-01-16 |
| 1790121291 | Advanced Medical Home Care, LLC | Home Health | 2555 County Road E East, Suite 101, White Bear Lake, MN 55110 | 2013-05-11 |
| 1134468465 | Emergency Physicians Professional Association | Clinic/Center | 1159 E. County Road E, Vadnais Heights, MN 55110 | 2013-02-06 |
| 1639444284 | Rebecca Lynn Blaede | Counselor | 4858 Banning Avenue, White Bear Lake, MN 55110 | 2012-03-15 |
| Find all providers in zip 55110 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043509425 | Century College Dental Hygiene Program | Clinic/Center | 3300 Century Ave N, East Campus - Dental Clinic, White Bear Lake, MN 55110-1842 | 2011-04-06 |
| 1801037437 | Isaacson Gentle Dentistry | Clinic/Center | 4700 White Bear Pkwy, White Bear Lake, MN 55110-3336 | 2009-03-11 |
| 1326206350 | Sydlewski Orthodontics | Clinic/Center | 2126 5th St, White Bear Lake, MN 55110-2717 | 2008-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033710025 | Theresa M. Snell | Clinic/Center | 580 5th Ave Nw Ste 100, New Brighton, MN 55112-2836 | 2020-11-05 |
| 1376143248 | James M. Williams, D.d.s., P.a. | Clinic/Center | 620 Union St S, Mora, MN 55051-1818 | 2020-10-29 |
| 1235746058 | Asp Dental, PC | Clinic/Center | 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345-4103 | 2020-09-25 |
| 1952918781 | Asp Dental, PC | Clinic/Center | 9800 Shelard Pkwy Ste 130, Plymouth, MN 55441-6451 | 2020-09-25 |
| 1518574532 | Stillwater Family Dental | Clinic/Center | 13481 60th St N Ste 100, Oak Park Heights, MN 55082-1089 | 2020-09-24 |
| 1093321531 | Barnett Dental Inc | Clinic/Center | 7962 Sunwood Dr Nw Ste 200, Ramsey, MN 55303-5172 | 2020-09-21 |
| 1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
| 1770195158 | Mark T. Sherman Dds Pa | Clinic/Center | 31011 Rasmussen Rd, Pequot Lakes, MN 56472-1227 | 2020-08-18 |
| 1689286015 | Lifelong Dental Care | Clinic/Center | 1525 Livingston Ave Ste B, West St Paul, MN 55118-3430 | 2020-08-18 |
| 1528678497 | Custom Smiles Dentistry, Pllc | Clinic/Center | 2258 Bunker Lake Blvd Nw, Andover, MN 55304-3900 | 2020-08-05 |
| Find all providers with the same taxonomy | ||||
| City | WHITE BEAR LAKE |
| Zip Code | 55110 |
Please comment or provide details below to improve the information on BIRCH LAKE 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.