Faith G Lira, DDS
Individual provider Active NPI Dentist · Albertville, MN
NPI 1629028345 · NPPES record last updated Oct 17, 2011
Key facts
- NPI
- 1629028345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D11470 (MN)
- Practice address
- 5047 Jason Ave NE
Albertville, MN 55301-9688 - Phone
- (763) 497-8165
- NPI assigned
- May 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11470 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnesota Dental Professionals, P.C. | Past |
Accepting new patients | |
| Albertville Family Dental | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D11470 | MN | Yes |
Addresses
Primary practice location
5047 Jason Ave NE
Albertville, MN 55301-9688
Mailing address
5047 Jason Ave NE
Albertville, MN 55301-9688
Phone (763) 497-8165
Other providers in Albertville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.