Lakeside Dental Associates, PA

Primary specialty

DentistTaxonomy code 122300000X

License

D11088 Issued in MN

Legal business name

LAKESIDE DENTAL ASSOCIATES, PA

Practice address

5331 E Superior St
Duluth, MN 55804-2423

Phone

(218) 525-1958

Fax

(218) 525-9219

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Todd Hansen, DDSNPI 1013089556

Title

President

Phone

(218) 525-1958

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Todd Hansen, DDS

  • Dentist
  • Duluth, MN
  • NPI 1013089556
  NPD (past) Authorized official

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801968342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5331 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558042423",
            "telephone_number": "218-525-1958",
            "fax_number": "218-525-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558042423",
            "telephone_number": "218-525-1958",
            "fax_number": "218-525-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DENTAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-525-1958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Duluth, MN
• Providers in Duluth, MN by specialty
• Dentist in Minnesota

• 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.