Lake Josephine Family Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKE JOSEPHINE FAMILY DENTAL LLC

Practice address

2960 Snelling Ave N
Roseville, MN 55113-2458

Phone

(651) 636-5033

Fax

(651) 636-5053

NPI assigned

May 2, 2022

Last updated

May 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sunnie F Adsitt, DDSNPI 1437417227

Title

Dentist/Owner

Phone

(651) 341-0129

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Sunnie F Adsitt, DDS

  • Dentist
  • Roseville, MN
  • NPI 1437417227
  NPD Authorized official
• Laura Jane Wild, DDS

  • Dentist
  • Roseville, MN
  • NPI 1912914235
  NPD (past)

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

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1366187643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 SNELLING AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132458",
            "telephone_number": "651-636-5033",
            "fax_number": "651-636-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 SNELLING AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132458",
            "telephone_number": "651-636-5033",
            "fax_number": "651-636-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE JOSEPHINE FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2022-05-02",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "ADSITT",
        "authorized_official_first_name": "SUNNIE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "651-341-0129",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Kutzke
• Juhee Kwon, MA, LPCC
• Louise Mae L'Allier, LMFT
• Brett David Lackie, DPT
• Steve Michael Lafond, PHARMD
• Jennifer Marie Lake, M.A., LMFT
• Katherine Hailey Lake, OTR/L
• David P Lambert, MD
• Elizabeth Lanari, LMFT
• Harlie Lane

• Dental Clinic/Center in Roseville, MN
• Providers in Roseville, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; 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.