Individual provider Active NPI

Katherine Lervick, DDS

  • Dentist
  • Minneapolis, MN
National Provider Identifier
1104926583
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11641 Issued in MN
Practice address
6601 Lyndale Ave S
Minneapolis, MN 55423-2477
Phone
(612) 825-1697
Fax
(612) 825-9826
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D11641 MN Primary

Addresses

Primary practice location

6601 Lyndale Ave S
Minneapolis, MN 55423-2477

Mailing address

PO Box 23029
Richfield, MN 55423-0029
Phone (612) 861-9123

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

LicenseStateTypeSpecialty
D11641MNMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Dentalcare, PLC Dentist Past Accepting new patients
Northland Dental Partners, PLLC PastSince Mar 20, 2022 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1104926583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23029",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554230029",
            "telephone_number": "612-861-9123",
            "fax_number": "612-861-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 LYNDALE AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554232477",
            "telephone_number": "612-825-1697",
            "fax_number": "612-825-9826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERVICK",
        "first_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.