NPIMap

Organization Active NPI

Lakes Dental Assoc PA

  • Dentist
  • Forest Lake, MN
National Provider Identifier
1255490389
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9362 Issued in MN
Legal business name
LAKES DENTAL ASSOC PA
Practice address
956 West Broadway
Forest Lake, MN 55025
Phone
(651) 464-7277
Fax
(651) 464-6857
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Rodney A Strensrud, DDS
Title
Owner Dentist
Phone
(651) 257-3246

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8907 MN
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 89338 MN
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 11000 MN
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 9362 MN Primary

Addresses

Primary practice location

956 West Broadway
Forest Lake, MN 55025

Mailing address

PO Box 278
Forest Lake, MN 55025
Phone (651) 257-3246

Other names 1

  • Lakes Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

956 W Broadway Ave
Forest Lake, MN 55025
Phone (651) 464-7277

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255490389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "55025",
            "telephone_number": "651-257-3246",
            "fax_number": "651-464-6857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "956 WEST BROADWAY",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "55025",
            "telephone_number": "651-464-7277",
            "fax_number": "651-464-6857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES DENTAL ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STRENSRUD",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "651-257-3246",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "8907",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "89338",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "11000",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "9362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakes Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Lake, 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.

Verify at the official NPI Registry.