NPIMap

Organization Active NPI

Lakeside Dentistry

  • General Practice Dentistry
  • Rochester, MN
National Provider Identifier
1457525875
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKESIDE DENTISTRY
Practice address
24 W Silver Lake Dr NE
Rochester, MN 55906-3640
Phone
(507) 282-8222
NPI assigned
Apr 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Lulu Gores
Title
Administrator
Phone
(507) 282-8222

Specialties & licenses 1

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

Addresses

Primary practice location

24 W Silver Lake Dr NE
Rochester, MN 55906-3640

Mailing address

24 W Silver Lake Dr NE
Rochester, MN 55906-3640

National Provider Directory

National Provider Directory

Locations

24 W Silver Lake Dr NE
Rochester, MN 55906
Phone (507) 282-8222

Practitioners & affiliated clinicians

Practitioners 6

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": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1457525875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 W SILVER LAKE DR NE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559063640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 W SILVER LAKE DR NE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559063640",
            "telephone_number": "507-282-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "GORES",
        "authorized_official_first_name": "LULU",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-282-8222"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.