Lake Street Family Dental PA

Primary specialty

DentistTaxonomy code 122300000X

License

D13567 Issued in MN

Legal business name

LAKE STREET FAMILY DENTAL PA

Practice address

119 Lake St S
Suite 1
Mora, MN 55051-1576

Phone

(320) 679-2435

NPI assigned

Jun 25, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Steven Nelson Holcombe, DMDNPI 1407238439

Title

President

Phone

(763) 350-6234

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Steven Nelson Holcombe, DMD

  • Dentist
  • Mora, MN
  • NPI 1407238439
  NPD (past) Authorized official

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1083096085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10799 251ST AVE NW",
            "city": "ZIMMERMAN",
            "state": "MN",
            "postal_code": "553984558",
            "telephone_number": "763-350-6234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 LAKE ST S",
            "address_2": "SUITE 1",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511576",
            "telephone_number": "320-679-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STREET FAMILY DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "HOLCOMBE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-350-6234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Mary Kroschel
• Ryan Richard Kroschel, M.D.
• Louisa Krueger, CNP
• Renee Elaine Lacroix, LPCC, LADC
• Scott W Lagaard, MD
• Joshua Larsen, LICSW
• Denise Marie Larson, D.O.
• Alaina Marie Lee, P.T.
• Legacy Counseling Services, Inc
• Patricia Rae Lind, PHARM D

• Dentist in Mora, MN
• Providers in Mora, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.