Eden Lakes Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EDEN LAKES DENTAL LLC

Practice address

9613 Anderson Lakes Pkwy
Eden Prairie, MN 55344-4155

Phone

(952) 941-0470

NPI assigned

May 12, 2023

Organization subpart

No

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

Authorized official

Name

Francesca Catibog, DDSNPI 1912439480

Title

Owner

Phone

(818) 626-6883

Specialties & licenses 1

Addresses

Other names 1

• Preserve Parkway Dental Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

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

• Francesca Catibog, DDS

  • General Practice Dentistry
  • Eden Prairie, MN
  • NPI 1912439480
  NPD Authorized official
• Jennifer Ann Hummel, D.D.S.

  • Dentist
  • Eden Prairie, MN
  • NPI 1790912863
  NPD (past)
• Dennis Lee Kavio, DDS

  • Dentist
  • Eden Prairie, MN
  • NPI 1376550996
  NPD (past)

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1902596943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 YORKTOWN LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697603",
            "telephone_number": "818-626-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9613 ANDERSON LAKES PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553444155",
            "telephone_number": "952-941-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN LAKES DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "CATIBOG",
        "authorized_official_first_name": "FRANCESCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-626-6883",
        "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": "Preserve Parkway Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katie Ann Eagle
• Ear Professionals International LLC
• Wade Rodney Eckhoff, D.C.
• Edan Oak LLC
• Kevin R Edelman, M.D.
• Eden Prairie Chiropractic Clinic Inc
• Eden Prairie Eye Care
• Eden Prairie Meals on Wheels
• Eden Prairie Orthodontic Assoc
• Eden Prairie School District 272

• Dental Clinic/Center in Eden Prairie, MN
• Providers in Eden Prairie, 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 12, 2023; 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.