Lake Area Dental

Key facts

NPI

1265248173

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

LAKE AREA DENTAL

Practice address

4801 Highway 61 N Ste 301
White Bear Lake, MN 55110-2753

Phone

(651) 762-8474

NPI assigned

Dec 5, 2024

Organization subpart

No

Authorized official

Name

Jordan Dittberner, DDS NPI 1174011597

Title

Dentist

Phone

(651) 308-1177

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

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

• Jordan Dittberner, DDS General Practice Dentistry · White Bear Lake, MN · NPI 1174011597
  NPD Authorized official
• Stephen William Jaksa, D.D.S, General Practice Dentistry · White Bear Lake, MN · NPI 1225146855
  NPD (past)

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 5, 2024.

{
    "created_epoch": "1733356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1265248173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 WILDWOOD CT",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551154200",
            "telephone_number": "651-308-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N STE 301",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102753",
            "telephone_number": "651-762-8474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AREA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-05",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "DITTBERNER",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "651-308-1177",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

• John Peter Kuske
• Marie Lafrance, MD
• Colet Stella Lahoz, RN L.AC.
• Jeffrey F Lahti, PT
• Lake and Valley Family Therapy LLC
• Lake Area Lawn
• Danielle Lake
• Jennifer A Lake, MD
• Lakeshore Family Dentistry PA
• Amelia Lane

All providers in White Bear Lake, MN · Dental Clinic/Center in Minnesota