CLD - Richfield MN, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLD - RICHFIELD MN, LLC

Doing business as

Clear Lakes Dental - Richfield

Practice address

704 W 66TH St
Richfield, MN 55423-2203

Phone

(612) 915-0015

Fax

(612) 915-0015

NPI assigned

May 6, 2024

Last updated

May 6, 2024By 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. David Park, DMD

Title

Ceo/President/Owner

Phone

(651) 444-9644

Specialties & licenses 1

Addresses

Other names 1

• Clear Lakes Dental - Richfield Doing business as

Locations

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1932956919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 W 66TH ST",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232203",
            "telephone_number": "612-915-0015",
            "fax_number": "612-915-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 W 66TH ST",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232203",
            "telephone_number": "612-915-0015",
            "fax_number": "612-915-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLD - RICHFIELD MN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clear Lakes Dental - Richfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna G Clancy
• Clarion4
• Jay Allen Clark, DDS
• Deborah Kim Clarke, L.AC.
• Katie Thi Clarkson, DNP
• Timothy Lamar Coats Jr. Jr.
• Sara M Colarusso, DDS
• Dana Collins, LMT
• Complementary Support Services
• Complementary Support Services

• Dental Clinic/Center in Richfield, MN
• Providers in Richfield, 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 6, 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.