HAM LAKE DENTAL PA NPI 1205915881

NPI Information

  • NPI: 1205915881
  • Provider Name: HAM LAKE DENTAL PA
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 17565 CENTRAL AVE NE
    HAM LAKE, MN
    ZIP 55304
  • Phone: (763) 434-4188

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NPI Details

HAM LAKE DENTAL PA is a general practice dentist in Ham Lake, MN. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. HAM LAKE DENTAL PA NPI is 1205915881. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

17565 CENTRAL AVE NE
HAM LAKE, MN
ZIP 55304
Phone: (763) 434-4188
Fax: (763) 413-7261

The provider's authorized official is Michele Marie Revoir .
The authorized official title is Dentist and has the following contact phone number (763) 434-4188.

The enumeration date for this NPI number is 11/3/2006 and was last updated on 8/22/2020.

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
11223G0001XDentistGeneral PracticeD10416MINNESOTANo
21223G0001XDentistGeneral PracticeD10544MINNESOTANo
31223G0001XDentistGeneral PracticeD9466MINNESOTANo
41223G0001XDentistGeneral PracticeD9362MINNESOTAYes

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: 11/21/2025

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