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General NPI Number Information
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NPI Number | 1255490389
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Entity Type | Organization
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Legal Business Name | LAKES DENTAL ASSOC PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 956 WEST BROADWAY
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City | FOREST LAKE
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State | MN
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Zip | 55025
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Country | US
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Telephone | 651-464-7277
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Fax | 651-464-6857
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | FOREST LAKE
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State | MN
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Zip | 55025
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Country | US
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Telephone | 651-257-3246
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Fax | 651-464-6857
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | RODNEY A STRENSRUD
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Credential | DDS
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Telephone | 651-257-3246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8907
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 89338
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11000
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9362
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License Number State | MN
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