Active NPI
City of Lakes Dental, P.a.
- General Practice Dentistry
- Minneapolis, MN
National Provider Identifier
1124192208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D8428
- Legal business name
- CITY OF LAKES DENTAL, P.A.
- Practice address
- 5524 Nicollet Ave
Minneapolis, MN 55419-1930 - Phone
- (612) 823-1816
- Fax
- (612) 823-5955
- NPI assigned
- Nov 20, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Herbert William Schulte, D.D.S.
- Title
- President
- Phone
- (612) 823-1816
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8428 | MN | Primary |
Addresses
Primary practice location
5524 Nicollet Ave
Minneapolis, MN 55419-1930
Mailing address
5524 Nicollet Ave
Minneapolis, MN 55419-1930
Phone (612) 823-1816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40 06726 | Other | MN | BLUE |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
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.
-
- General Practice Dentistry
- Minneapolis, MN
- NPI 1427122696
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1124192208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5524 NICOLLET AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554191930",
"telephone_number": "612-823-1816",
"fax_number": "612-823-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5524 NICOLLET AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554191930",
"telephone_number": "612-823-1816",
"fax_number": "612-823-5955"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CITY OF LAKES DENTAL, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SCHULTE",
"authorized_official_first_name": "HERBERT",
"authorized_official_middle_name": "WILLIAM",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "612-823-1816",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D8428",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE",
"identifier": "40 06726",
"state": "MN"
}
],
"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 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.