Central Lakes Community Dental Clinic

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

Legal business name

CENTRAL LAKES COMMUNITY DENTAL CLINIC

Practice address

11600 State Ave.
Suite a
Brainerd, MN 56401

Phone

(218) 855-8600

Fax

(651) 431-7355

NPI assigned

Jan 26, 2007

Last updated

Jan 7, 2026By 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

Lynn Glancey

Title

Chief Financial Officer

Phone

(651) 539-7200

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Susan K Dudding, CNP

  • Family Nurse Practitioner
  • Brainerd, MN
  • NPI 1659434744
  NPD (past)
• John Phillip Koop, PHARM. D.

  • Pharmacotherapy Pharmacist
  • Brainerd, MN
  • NPI 1679648414
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1467508226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD.",
            "address_2": "SUITE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186",
            "telephone_number": "651-539-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 STATE AVE.",
            "address_2": "SUITE A",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "56401",
            "telephone_number": "218-855-8600",
            "fax_number": "651-431-7355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11615 State Ave.",
            "address_purpose": "LOCATION",
            "city": "Brainerd",
            "state": "MN",
            "postal_code": "56401",
            "country_code": "US",
            "telephone_number": "218-855-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRAL LAKES COMMUNITY DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "GLANCEY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "651-539-7200"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "970826000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelagh Doherty Carlson, PT
• Sara Carmona
• Stefany Carvalho, DPM
• Richard V Castle, D.O.
• Angella Lynn Cekalla, LICSW
• Central Minnesota Dermatology, PA
• Central Minnesota Sleep Specialists, PLC
• Central MN Pediatric Dentists, PA
• Sonya K Chamberlain, LM, CPM
• Aaron James Chan, M.D.

• Public Health Dentistry in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Public Health Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; 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.