CLD - Rochester MN, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLD - ROCHESTER MN, LLC

Practice address

2765 Commerce Dr NW Ste 230
Rochester, MN 55901-2987

Phone

(507) 218-8815

Fax

(507) 218-8815

NPI assigned

May 30, 2024

Organization subpart

No

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

Authorized official

Name

Dr. David Park, DMD

Title

Ceo/President/Owner

Phone

(651) 444-9644

Specialties & licenses 1

Addresses

Other names 1

• Clear Lakes Dental Doing business as

Locations

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

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1821838384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2765 COMMERCE DR NW STE 230",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559012987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2765 COMMERCE DR NW STE 230",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559012987",
            "telephone_number": "507-218-8815",
            "fax_number": "507-218-8815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLD - ROCHESTER MN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO/PRESIDENT/OWNER",
        "authorized_official_telephone_number": "651-444-9644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clear Lakes Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ricky P Clay, M.D.
• David W Claypool, M.D.
• Mary K Claypool, PT
• Amy C Clayton, M.D.
• Charles H Clayton III, PA-C
• Clear Wave Hearing Instruments Inc
• Colin Matthew Cleary, MD
• Emmett J Cleary, MD
• Sean Cleary, MD
• Anna Marie Clemens, MD

• Dental Clinic/Center in Rochester, MN
• Providers in Rochester, 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 May 30, 2024; 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.