Forest Lake Smiles, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FOREST LAKE SMILES, PA

Practice address

1068 Lake St S
Forest Lake, MN 55025-2639

Phone

(651) 464-8207

NPI assigned

Apr 11, 2019

Last updated

Apr 11, 2019By 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

Sarah Burt

Title

Director of Operations

Phone

(651) 243-5999

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1699238139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550560220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 LAKE ST S",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252639",
            "telephone_number": "651-464-8207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST LAKE SMILES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-11",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "BURT",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "651-243-5999"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Forest Lake Endodontics
• Forest Lake Home Care Inc
• Forest Lake Optometric Center (North Woods Optics)
• Forest Lake Orthodontics (Travis W. Wille, DDS, MS)
• Forest Lake Skin and Vein Clinic
• Lisa Marie Forslund, CNP
• Harvey J Frank, MD
• Alicen Fritzinger
• Sondra Decker Fruzzetti, M.S.W., LSCSW
• G2 Dental

• Dental Clinic/Center in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.