NPIMap

Organization Active NPI

Lakeshore Dental

  • General Practice Dentistry
  • Minneapolis, MN
National Provider Identifier
1356801799
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKESHORE DENTAL
Practice address
4700 Cedar Ave S
Minneapolis, MN 55407-3634
Phone
(240) 765-4938
NPI assigned
Mar 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

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

Authorized official

Name
Dr. Mohamed M Ali, DDSNPI 1154811404
Title
Owner
Phone
(240) 765-4938

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4700 Cedar Ave S
Minneapolis, MN 55407-3634

Mailing address

4700 Cedar Ave S
Minneapolis, MN 55407-3634

National Provider Directory

National Provider Directory

Locations

4700 Cedar Ave S
Minneapolis, MN 55407
Phone (240) 765-4938

Practitioners & affiliated clinicians

Practitioners 1

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": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1356801799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 CEDAR AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 CEDAR AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073634",
            "telephone_number": "240-765-4938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-765-4938",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "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 Mar 21, 2019; 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.