Lisa Kathleen Amundson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12460 Issued in MN

Practice address

6939 Pine Arbor Dr S
Suite A104
Cottage Grove, MN 55016-4580

Phone

(651) 459-3514

NPI assigned

Oct 9, 2007

Last updated

Oct 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amundson Family Dentistry

  • Dental Clinic/Center
  • Cottage Grove, MN
  • NPI 1043656168
  Authorized official Same address or phone

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1134317712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6939 PINE ARBOR DR S",
            "address_2": "SUITE A104",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164580",
            "telephone_number": "651-459-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6939 PINE ARBOR DR S",
            "address_2": "SUITE A104",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550164580",
            "telephone_number": "651-459-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMUNDSON",
        "first_name": "LISA",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allina Health System (Allina Health Cottage Grove Clinic)
• Allina Health System (Allina Health Cottage Grove Pharmacy)
• Amaani House (Amira House)
• Amerigrace Home Care LLC
• Amundson Family Dentistry
• Tanya Marie Anderson, CCC-SLP
• Hillary Marie Andrews
• Craig Lyman Anshus, D.C.
• Martha Name Asare-Dokyi
• Assisted Living Store, Incorporated

• General Practice Dentistry in Cottage Grove, MN
• Providers in Cottage Grove, 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 Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.