NPIMap

Organization Active NPI

Lakes Dental Care PLC

  • General Practice Dentistry
  • Baxter, MN
National Provider Identifier
1609889302
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKES DENTAL CARE PLC
Practice address
14213 Golf Course Dr
Suite 100
Baxter, MN 56425
Phone
(218) 829-4511
Fax
(218) 829-5483
NPI assigned
Aug 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jeffrey Emerald Olson, DDSNPI 1639182330
Title
Owner Partner
Phone
(218) 829-4511

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: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

14213 Golf Course Dr
Suite 100
Baxter, MN 56425

Mailing address

14213 Golf Course Dr
Suite 100
Baxter, MN 56425
Phone (218) 829-4511

National Provider Directory

National Provider Directory
Tax ID family
Lakes Dental Care PLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14213 Golf Course Dr
#100
Baxter, MN 56425
Phone (218) 829-4511

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": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609889302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14213 GOLF COURSE DR",
            "address_2": "SUITE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-829-4511",
            "fax_number": "218-829-5483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14213 GOLF COURSE DR",
            "address_2": "SUITE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-829-4511",
            "fax_number": "218-829-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES DENTAL CARE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "EMERALD",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "218-829-4511",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.