Birch Lake Dental PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10949MN Issued in MN

Legal business name

BIRCH LAKE DENTAL PA

Practice address

2641 White Bear Parkway
White Bear Lake, MN 55110

Phone

(651) 429-0404

Fax

(651) 429-0472

NPI assigned

Feb 12, 2009

Last updated

Feb 12, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Geetha J Damodaran, D.D.S.NPI 1275858078

Title

Owner

Phone

(651) 429-0404

Specialties & licenses 2

Addresses

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.

• Geetha J Damodaran, D.D.S.

  • Dentist
  • White Bear Lake, MN
  • NPI 1275858078
  Authorized official Same address or phone

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1083853113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 WHITE BEAR PARKWAY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55110",
            "telephone_number": "651-429-0404",
            "fax_number": "651-429-0472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2641 WHITE BEAR PARKWAY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55110",
            "telephone_number": "651-429-0404",
            "fax_number": "651-429-0472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH LAKE DENTAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "DAMODARAN",
        "authorized_official_first_name": "GEETHA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-429-0404",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10949MN",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "7712MN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy Bexell
• Mulatu Geleto Bino
• Birch Behavioral Medicine, PLLC
• Birch Lake Chiropractic Clinic, LLC
• Birch Lake Dental
• Birch Lake Professional Counseling Group, Inc.
• Birch Lake Vision Group, LLC. (Birch Lake Eye Clinic, Oak Tree Optical, Village Eye Clinic and Optica)
• Ami Bischel
• Rebecca Lynn Blaede
• Julie Blaske, MA LADC LMFT

• General Practice Dentistry in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; 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.