NPIMap

Organization Active NPI

Glen Lake Dental Associates, P.a.

  • General Practice Dentistry
  • Minnetonka, MN
National Provider Identifier
1003062084
Registry record updated Aug 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9306 Issued in MN
Legal business name
GLEN LAKE DENTAL ASSOCIATES, P.A.
Practice address
14418 Excelsior Blvd
Minnetonka, MN 55345-5820
Phone
(952) 935-5212
Fax
(952) 935-1391
NPI assigned
Aug 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kent Cassidy, D.D.S.NPI 1093796005
Title
President
Phone
(952) 935-5212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D9306 MN Primary

Addresses

Primary practice location

14418 Excelsior Blvd
Minnetonka, MN 55345-5820

Mailing address

14418 Excelsior Blvd
Minnetonka, MN 55345-5820
Phone (952) 935-5212

National Provider Directory

National Provider Directory

Locations

14418 Excelsior Blvd
Minnetonka, MN 55345
Phone (952) 935-5212

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1003062084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14418 EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455820",
            "telephone_number": "952-935-5212",
            "fax_number": "952-935-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14418 EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455820",
            "telephone_number": "952-935-5212",
            "fax_number": "952-935-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN LAKE DENTAL ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-11",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "CASSIDY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-935-5212",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.