NPIMap

Organization Active NPI

Center Lake Dental, PA

  • Dental Clinic/Center
  • Center City, MN
National Provider Identifier
1871954651
Registry record updated Mar 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CENTER LAKE DENTAL, PA
Doing business as
Bayview Dental
Practice address
420 Grand Ave
Center City, MN 55012-3553
Phone
(651) 257-1140
NPI assigned
Mar 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2016

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

Authorized official

Name
Dr. Geoffrey D Archibald, DDS
Title
Owner
Phone
(651) 674-7096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

420 Grand Ave
Center City, MN 55012-3553

Mailing address

420 Grand Ave
Center City, MN 55012-3553
Phone (651) 257-1140

Other names 1

  • Bayview Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457395200000",
    "number": "1871954651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 GRAND AVE",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550123553",
            "telephone_number": "651-257-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GRAND AVE",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550123553",
            "telephone_number": "651-257-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER LAKE DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2016-03-08",
        "status": "A",
        "authorized_official_last_name": "ARCHIBALD",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-674-7096",
        "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": [
        {
            "organization_name": "Bayview Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Center City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; 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.