Lake Street Dental
Legal Business Name
Lake Street Dental
NPI Number
1184829509
NPI Type
Organization
Enumeration Date
06/16/2007
Specialties
(Taxonomies)Code
1223G0001X
1223P0300X
1223P0700X
Primary Taxonomy
No
No
No
Licenses
State
Minnesota
Minnesota
Minnesota
License Number
D11889
D11718
D12007
Contact
Information
Purpose
Mailing
Location
Address
1508 E LAKE ST
1508 E LAKE ST
City
Minneapolis
Minneapolis
State
MN
MN
Postal Code
55407-1720
55407-1720
Country
US
US
Telephone Number
(612) 724-1717
(612) 724-1717
Authorized Official
Name
Renee Good
Title or Position
PERIOSONTIST
Telephone Number
(612) 724-1717
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/22/2020