NPIMap

Organization Active NPI

Chicago Lake Dental

  • General Practice Dentistry
  • Minneapolis, MN
National Provider Identifier
1497936389
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9512 Issued in MN
Legal business name
CHICAGO LAKE DENTAL
Practice address
2900 Chicago Ave
Minneapolis, MN 55407-1322
Phone
(612) 823-2080
Fax
(612) 823-5777
NPI assigned
Nov 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Dr. David William Johnson Jr., DDSNPI 1154325017
Title
Owner
Phone
(612) 823-2080

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 D9512 MN Primary

Addresses

Primary practice location

2900 Chicago Ave
Minneapolis, MN 55407-1322

Mailing address

2900 Chicago Ave
Minneapolis, MN 55407-1322
Phone (612) 823-2080

National Provider Directory

National Provider Directory

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": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1497936389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071322",
            "telephone_number": "612-823-2080",
            "fax_number": "612-823-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071322",
            "telephone_number": "612-823-2080",
            "fax_number": "612-823-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO LAKE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-823-2080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9512",
            "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 Nov 19, 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.

Verify at the official NPI Registry.