NPIMap

Organization Active NPI

Ham Lake Dental PLLC

  • Dental Clinic/Center
  • Andover, MN
National Provider Identifier
1104400845
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
HAM LAKE DENTAL PLLC
Practice address
16220 Aberdeen St NE Ste A1
Andover, MN 55304-5421
Phone
(763) 415-7831
NPI assigned
May 10, 2021
Organization subpart
No

Practitioners 1

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

National Provider Directory

National Provider Directory

Locations

16220 Aberdeen St NE
Ste A1
Ham Lake, MN 55304
Phone (763) 415-7831

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Authorized official

Name
Dr. Alex Shnaydruk, DDSNPI 1306402193
Title
Dentist
Phone
(952) 261-4307

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

16220 Aberdeen St NE Ste A1
Andover, MN 55304-5421

Mailing address

16220 Aberdeen St NE Ste A1
Andover, MN 55304-5421
Phone (763) 415-7831

Other names 1

  • Ham Lake Dental PLLC Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1104400845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16220 ABERDEEN ST NE STE A1",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553045421",
            "telephone_number": "763-415-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16220 ABERDEEN ST NE STE A1",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553045421",
            "telephone_number": "763-415-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAM LAKE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "SHNAYDRUK",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "952-261-4307",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ham Lake Dental PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Andover, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.