Lake Superior Dental Associates

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKE SUPERIOR DENTAL ASSOCIATES

Practice address

1225 E 1St St
Duluth, MN 55805-2402

Phone

(218) 728-6445

Fax

(218) 724-7003

NPI assigned

Nov 3, 2006

Last updated

Oct 30, 2007By 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

Dr. Robert G Ryan, DDSNPI 1952488132

Title

Partner

Phone

(218) 728-6445

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 21

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.

• Robert G Ryan, DDS

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1952488132
  Medicare reassignment NPD Authorized official
• Seth Amadio, D.D.S

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1427369677
  Medicare reassignment NPD
• Paul D Bartlam, DDS

  • General Practice Dentistry
  • Cloquet, MN
  • NPI 1720167943
  Medicare reassignment NPD
• Simon Broccard, DDS

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1447999867
  Medicare reassignment NPD
• Robert Alexander Johnson, DMD

  • Dentist
  • Cloquet, MN
  • NPI 1093200826
  Medicare reassignment NPD
• Melanie Sue Meier Buhr, D.D.S.

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1639183726
  Medicare reassignment NPD
• Meaghan Elizabeth Morrell, D.D.S

  • Dentist
  • Hermantown, MN
  • NPI 1356661516
  Medicare reassignment NPD
• Jeffrey Polzin, D.M.D.

  • Dentist
  • Duluth, MN
  • NPI 1649687674
  Medicare reassignment NPD
• Eric D Iwen, DDS

  • General Practice Dentistry
  • Superior, WI
  • NPI 1871723593

  MN

  Medicare reassignment NPD
• Vanessa Kristine Strom Olson, DDS

  • Dentist
  • Salem, OR
  • NPI 1942304407

  MN

  Medicare reassignment NPD
• Ross Allen Anderson, D.D.S.

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1891011748
  Medicare reassignment
• Anne Davis, RDH, DT

  • Dental Therapist
  • Duluth, MN
  • NPI 1043940257
  NPD

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1871672584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052402",
            "telephone_number": "218-728-6445",
            "fax_number": "218-724-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052402",
            "telephone_number": "218-728-6445",
            "fax_number": "218-724-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SUPERIOR DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "218-728-6445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "7B014FO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "820436",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Superior Community Health Center
• Lake Superior Community Health Center
• Lake Superior Community Health Center
• Lake Superior Concierge, Inc.
• Lake Superior Counseling Center
• Lake Superior Internal Medicine
• Lake Superior Medical Equipment Inc
• Lake Superior Physical Therapy Inc
• Lake Vision PLLC
• Ronald Lake, MSW LICSW

• General Practice Dentistry in Duluth, MN
• Providers in Duluth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.