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LAKE STREET FAMILY DENTAL PA NPI 1083096085


NPI Information

NPI: 1083096085
Provider Name: LAKE STREET FAMILY DENTAL PA
Classification: Dentist - 122300000X
Entity Type: Organization
Address:
119 LAKE ST S
SUITE 1
MORA, MN
ZIP 55051
Phone: (320) 679-2435
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LAKE STREET FAMILY DENTAL PA is a dentist in Mora, MN. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. LAKE STREET FAMILY DENTAL PA NPI is 1083096085. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

119 LAKE ST S
SUITE 1
MORA, MN
ZIP 55051-576
Phone: (320) 679-2435

The provider's authorized official is Steven Nelson Holcombe .
The authorized official title is President and has the following contact phone number (763) 350-6234.

The enumeration date for this NPI number is 6/25/2015 and was last updated on 6/25/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122300000XDentistD13567MINNESOTAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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