Forest Lake Endodontics

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

FOREST LAKE ENDODONTICS

Doing business as

Forest Lake Endodontics

Practice address

1420 Lake St S Ste 200
Forest Lake, MN 55025-2713

Phone

(651) 464-9888

NPI assigned

Aug 25, 2020

Last updated

Sep 8, 2020By 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

Renee Irene Klossner

Title

Office Manager

Phone

(651) 464-9888

Specialties & licenses 1

Addresses

Other names 1

• Forest Lake Endodontics Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Ann J Bunczak Reeh, DDS MS

  • Endodontics
  • Stillwater, MN
  • NPI 1184718108
  NPD

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1871106393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 LAKE ST S STE 200",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252713",
            "telephone_number": "651-464-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 LAKE ST S STE 200",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252713",
            "telephone_number": "651-464-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST LAKE ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-25",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "KLOSSNER",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "651-464-9888"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Desktop",
            "affiliation": "N",
            "endpointDescription": "Desktop",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1420 Lake St S Ste 200",
            "city": "Forest Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550252713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Forest Lake Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brenda Lee Fandel, D.C.
• Colleen Michelle Flaten
• Neh Buma Foncham, PSYCHIATRIC NP
• Forest Lake Area Schools #831
• Forest Lake Chiropractic Clinic, P.a.
• 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
• Forest Lake Smiles, PA

• Endodontics in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Endodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.