OrganizationActive
Lake Street Dental
NPI 1184829509 · Prosthodontics · Minneapolis, MN
Lake Street Dental is a Prosthodontics organization in Minneapolis, MN (NPI 1184829509).
Provider details
- NPI number
- 1184829509
- Entity type
- Organization
- Primary specialty
- ProsthodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Renee Good, Periosontist(612) 724-1717
- License
- D11889 (MN)
Specialties & taxonomies
Dental Providers
Dental Providers
Dental Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1508 E Lake St
Minneapolis, MN 55407-1720
Phone: (612) 724-1717
Street-level locationGet directions
Mailing address
1508 E Lake St
Minneapolis, MN 55407-1720
Registry dates
- Enumerated
- 2007-06-16
- Last updated
- 2025-09-11
Frequently asked questions
- What is Lake Street Dental's NPI number?
- Lake Street Dental's National Provider Identifier (NPI) is 1184829509, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lake Street Dental?
- Lake Street Dental is classified in the NPPES registry as Prosthodontics (Dental Providers).
- Where is Lake Street Dental located?
- Lake Street Dental's practice location on file with NPPES is 1508 E Lake St, Minneapolis, MN 55407-1720.
- What is Lake Street Dental's phone number?
- The practice phone number listed in the NPPES registry for Lake Street Dental is (612) 724-1717.
- Who is the authorized official for Lake Street Dental?
- The authorized official listed on Lake Street Dental's NPPES record is Renee Good, Periosontist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lake Street Dental's NPI active?
- Yes — Lake Street Dental's NPI (1184829509) is active in the NPPES registry as of the last update on 2025-09-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.