Active NPI
Jack Dailey, DDS
- Dentist
- Minneapolis, MN
National Provider Identifier
1144150384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D15432
- Practice address
- 4103 E Lake St
Minneapolis, MN 55406-2259 - Phone
- (612) 721-2424
- NPI assigned
- May 20, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D15432 | MN | Primary |
Addresses
Primary practice location
4103 E Lake St
Minneapolis, MN 55406-2259
Mailing address
6399 Barrie Rd
Edina, MN 55435-2201
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
| License | State | Type | Specialty |
|---|---|---|---|
| D15432 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West River Dental Care | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Minneapolis, MN
- NPI 1033223581
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1144150384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6399 BARRIE RD",
"city": "EDINA",
"state": "MN",
"postal_code": "554352201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4103 E LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554062259",
"telephone_number": "612-721-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAILEY",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-20",
"last_updated": "2026-05-20",
"certification_date": "2026-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D15432",
"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 May 20, 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.