Healthcare Provider Details

I. General information

NPI: 1538080171
Provider Name (Legal Business Name): LAHIRI VILAS NAIKWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E LAKE ST
MINNEAPOLIS MN
55407-1617
US

IV. Provider business mailing address

3425 CHANDLER RD
SHOREVIEW MN
55126-3915
US

V. Phone/Fax

Practice location:
  • Phone: 612-827-7181
  • Fax:
Mailing address:
  • Phone: 651-500-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15535
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: