NPIMap

Organization Active NPI

Glacier Lake Dental P a

  • Dental Clinic/Center
  • Lakeville, MN
National Provider Identifier
1780235747
Registry record updated Sep 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GLACIER LAKE DENTAL P A
Practice address
10450 185TH St W Ste 500
Lakeville, MN 55044-6690
Phone
(952) 435-9888
Fax
(952) 435-9820
NPI assigned
Sep 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2019

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

Authorized official

Name
Dr. Tracy Lu Grasdal, DDSNPI 1033238720
Title
President
Phone
(952) 486-2595

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

10450 185TH St W Ste 500
Lakeville, MN 55044-6690

Mailing address

10450 185TH St W Ste 500
Lakeville, MN 55044-6690
Phone (952) 435-9888

National Provider Directory

National Provider Directory

Locations

10450 185th St W
Ste 500
Lakeville, MN 55044
Phone (952) 435-9888

Practitioners & affiliated clinicians

Practitioners 2

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": "1569024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569024000000",
    "number": "1780235747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 185TH ST W STE 500",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446690",
            "telephone_number": "952-435-9888",
            "fax_number": "952-435-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 185TH ST W STE 500",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446690",
            "telephone_number": "952-435-9888",
            "fax_number": "952-435-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER LAKE DENTAL P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-21",
        "last_updated": "2019-09-21",
        "status": "A",
        "authorized_official_last_name": "GRASDAL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-486-2595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.