NPIMap

Organization Active NPI

Interlachen Dental Associates

  • General Practice Dentistry
  • Edina, MN
National Provider Identifier
1437847654
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
INTERLACHEN DENTAL ASSOCIATES
Practice address
5101 Vernon Ave S
Ste 1B
Edina, MN 55436-2171
Phone
(952) 920-9579
Fax
(952) 920-9298
NPI assigned
Apr 26, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Dr. Kevin Liberko, DDSNPI 1962850545
Title
Owner
Phone
(952) 920-9579

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

5101 Vernon Ave S
Ste 1B
Edina, MN 55436-2171

Mailing address

5101 Vernon Ave S
Ste 1B
Edina, MN 55436-2171
Phone (952) 920-9579

National Provider Directory

National Provider Directory

Locations

5101 Vernon Ave S
Ste 1B
Edina, MN 55436
Phone (952) 920-9579

Practitioners & affiliated clinicians

Practitioners 5

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": "1682467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1437847654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVE S",
            "address_2": "STE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362171",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVE S",
            "address_2": "STE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362171",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERLACHEN DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "LIBERKO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-920-9579",
        "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 Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.