NPIMap

Organization Active NPI

Morris Dental Clinic, PA

Doing business as Laketown Dental

  • General Practice Dentistry
  • Annandale, MN
National Provider Identifier
1295100626
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MORRIS DENTAL CLINIC, PA
Doing business as
Laketown Dental
Practice address
300 Park Street East
Annandale, MN 55302
Phone
(320) 274-8555
NPI assigned
Dec 10, 2015
Last updated
Dec 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Authorized official

Name
Eric Jere Rambow, DDSNPI 1154556793
Title
Dentist/President
Phone
(320) 589-2161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

300 Park Street East
Annandale, MN 55302

Mailing address

300 Park St E
Annandale, MN 55302-1207
Phone (320) 274-8555

Other names 1

  • Laketown Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Laketown Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1295100626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PARK ST E",
            "city": "ANNANDALE",
            "state": "MN",
            "postal_code": "553021207",
            "telephone_number": "320-274-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PARK STREET EAST",
            "city": "ANNANDALE",
            "state": "MN",
            "postal_code": "55302",
            "telephone_number": "320-274-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORRIS DENTAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "RAMBOW",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "JERE",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "320-589-2161",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laketown Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Annandale, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.