NPIMap

Organization Active NPI

Lakeville Dental Associates, PA

  • General Practice Dentistry
  • Lakeville, MN
National Provider Identifier
1053614867
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D12108 Issued in MN
Legal business name
LAKEVILLE DENTAL ASSOCIATES, PA
Practice address
20171 Icenic TRL
Lakeville, MN 55044-7708
Phone
(952) 469-3300
NPI assigned
Dec 16, 2010
Last updated
Oct 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Authorized official

Name
Mrs. Rose A Harrison
Title
Manager
Phone
(952) 469-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D12108 MN Primary

Addresses

Primary practice location

20171 Icenic TRL
Lakeville, MN 55044-7708

Mailing address

20171 Icenic TRL
Lakeville, MN 55044-7708
Phone (952) 469-3300

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1292457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318809600000",
    "number": "1053614867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20171 ICENIC TRL",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447708",
            "telephone_number": "952-469-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20171 ICENIC TRL",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447708",
            "telephone_number": "952-469-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVILLE DENTAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-16",
        "last_updated": "2011-10-17",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "952-469-3300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.