Lake Street Dental

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

D12007 Issued in MN

Legal business name

LAKE STREET DENTAL

Practice address

1508 E Lake St
Minneapolis, MN 55407-1720

Phone

(612) 724-1717

NPI assigned

Jun 16, 2007

Organization subpart

No

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

Authorized official

Name

Renee Camara Good, D.D.S., M.S.

Title

Periosontist

Phone

(612) 724-1717

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1181952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1184829509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071720",
            "telephone_number": "612-724-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071720",
            "telephone_number": "612-724-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STREET DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-16",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GOOD",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "CAMARA",
        "authorized_official_title_or_position": "PERIOSONTIST",
        "authorized_official_telephone_number": "612-724-1717",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11889",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D11718",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "MN",
            "license": "D12007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lake Nicollet Clinic, PA
• Lake Nokomis Home Health Care Inc
• Lake Pointe Chiropractic Centre (Lake Pointe Chiropractic & Wellness)
• Lake Street Pain Relief Center, Inc
• Lake Transportation Inc
• Lake Victoria Mental Health Services, PC
• John Richard Lake, MD
• Kaitlyn Taylor Lake, MS

• Prosthodontics in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Prosthodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.