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LAKE STREET DENTAL
NPI 1184829509
Dentist - Prosthodontics in Minneapolis, MN

Active since June 16, 2007
1508 E LAKE ST, MINNEAPOLIS, MN 55407(612) 724-1717 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Lake Street Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE STREET DENTAL (NPI 1184829509) is a healthcare organization registered as a prosthodontics in Minneapolis, Minnesota and active in the NPI registry since June 2007. The organization lists Renee Camara Good, Periosontist, as its authorized official.

NPPES Registry Identity

NPI1184829509
Entity TypeOrganization
Primary Taxonomy1223P0700X
Legal Business NameLAKE STREET DENTAL
Location Address1508 E LAKE STMinneapolis, MN 55407-1720
Mailing Address1508 E Lake StMinneapolis, MN 55407-1720 · (612) 724-1717
Phone(612) 724-1717
Organization SubpartNo
Authorized OfficialRenee Camara GoodPeriosontist · (612) 724-1717
Enumeration DateJune 16, 2007
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1184829509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDentist · ProsthodonticsDental Providers
Taxonomy Code1223P0700X
License✔ Licensed in MN · D12007
Definition
That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes.
Also ListedDentist · General PracticeTaxonomy 1223G0001X · License D11889 (MN)
Also ListedDentist · PeriodonticsTaxonomy 1223P0300X · License D11718 (MN)
1508 E LAKE ST, Minneapolis, MN 55407
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BUCCA DENTAL LLC
Clinic/Center (Dental)
1508 E LAKE ST
MINNEAPOLIS, MN 55407
Hennepin County (612) 724-1717

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Street Dental's NPI number?

The NPI number for Lake Street Dental is 1184829509. It was assigned to this organization in the NPPES registry on June 16, 2007.

Where is Lake Street Dental located?

Lake Street Dental is located at 1508 E Lake St, Minneapolis, MN 55407. The listed phone number is (612) 724-1717.

What is Lake Street Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Prosthodontics, with taxonomy code 1223P0700X.

When was this NPI record last updated?

The NPPES record for Lake Street Dental was last updated on September 11, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.