Active NPI
Glenn I Lepor, DDS
- Periodontics
- Minneapolis, MN
National Provider Identifier
1417020017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D10650
- Practice address
- 3909 Silver Lake Rd NE
Minneapolis, MN 55421-4352 - Phone
- (612) 789-3573
- Fax
- (612) 789-9669
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D10650 | MN | Primary |
Addresses
Primary practice location
3909 Silver Lake Rd NE
Minneapolis, MN 55421-4352
Mailing address
3909 Silver Lake Rd NE
Minneapolis, MN 55421-4352
Phone (612) 789-3573
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10650 | MN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417020017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3909 SILVER LAKE RD NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554214352",
"telephone_number": "612-789-3573",
"fax_number": "612-789-9669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3909 SILVER LAKE RD NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554214352",
"telephone_number": "612-789-3573",
"fax_number": "612-789-9669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEPOR",
"first_name": "GLENN",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MN",
"license": "D10650",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.