NPIMap

Organization Active NPI

Lakeshore Family Dentistry PA

  • General Practice Dentistry
  • White Bear Lake, MN
National Provider Identifier
1669585154
Registry record updated Aug 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8263 Issued in MN
Legal business name
LAKESHORE FAMILY DENTISTRY PA
Practice address
4706 Banning Ave
White Bear Lake, MN 55110
Phone
(651) 429-3348
Fax
(651) 429-3945
NPI assigned
Aug 17, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ms. Jonni D Delgreco
Title
Office Manager
Phone
(651) 429-3348

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

4706 Banning Ave
White Bear Lake, MN 55110
Phone (651) 429-3348

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 8263 MN Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9253 MN
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 10994 MN

Addresses

NPPES NPI Registry

Primary practice location

4706 Banning Ave
White Bear Lake, MN 55110

Mailing address

4706 Banning Ave
White Bear Lake, MN 55110
Phone (651) 429-3348

Other names 1

NPPES NPI Registry
  • A.K.A. Kenyon, Wright & Kron DDS PA Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 7, 2008.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1669585154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4706 BANNING AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55110",
            "telephone_number": "651-429-3348",
            "fax_number": "651-429-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4706 BANNING AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55110",
            "telephone_number": "651-429-3348",
            "fax_number": "651-429-3945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE FAMILY DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "DELGRECO",
        "authorized_official_first_name": "JONNI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "651-429-3348",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "8263",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9253",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10994",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A.K.A. Kenyon, Wright & Kron DDS PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in White Bear Lake, MN

Sources for this page

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