Active NPI
Daniel F Pink, DDS
- Dentist
- Forest Lake, MN
National Provider Identifier
1003975137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11000
- Practice address
- 956 West Broadway
Lakes Dental Clinic
Forest Lake, MN 55025 - Phone
- (651) 464-7277
- Fax
- (651) 464-6857
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11000 | MN | Primary |
Addresses
Primary practice location
956 West Broadway
Lakes Dental Clinic
Forest Lake, MN 55025
Mailing address
919 SE 18TH Street
Forest Lake, MN 55025
Phone (651) 982-4579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11000 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakes Dental Assoc PA | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Forest Lake, MN
- NPI 1255490389
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003975137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 SE 18TH STREET",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "55025",
"telephone_number": "651-982-4579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "956 WEST BROADWAY",
"address_2": "LAKES DENTAL CLINIC",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "55025",
"telephone_number": "651-464-7277",
"fax_number": "651-464-6857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINK",
"first_name": "DANIEL",
"middle_name": "F",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "11000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.