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GLEN LAKE FAMILY DENTISTRY P.L.L.C. NPI 1740215656


NPI Information

NPI: 1740215656
Provider Name: GLEN LAKE FAMILY DENTISTRY P.L.L.C.

Doing Business As: NONE

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
5509 EDEN PRAIRIE RD
MINNETONKA, MN
ZIP 55345
Phone: (952) 938-6038
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GLEN LAKE FAMILY DENTISTRY P.L.L.C. is a general practice dentist in Minnetonka, 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. GLEN LAKE FAMILY DENTISTRY P.L.L.C. NPI is 1740215656. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As None.

The provider's business location address is:

5509 EDEN PRAIRIE RD
MINNETONKA, MN
ZIP 55345-839
Phone: (952) 938-6038
Fax: (952) 935-9175

The provider's authorized official is Gregory Alan Olson .
The authorized official title is Dentist and has the following contact phone number (952) 938-6038.

The enumeration date for this NPI number is 7/11/2006 and was last updated on 10/21/2009.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral PracticeD11282/D10240MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1674718300OTHERMINNESOTASTATE MEDICAL ASSISTANCE#

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: 4/28/2024

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