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SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
NPI 1376409276
Dentist in Minneapolis, MN

Active since January 05, 2026CLIA 24D1043439 · Microscopy
1000 E LAKE ST, MINNEAPOLIS, MN 55407(612) 822-9030(612) 821-2818 Get Directions Write a Review

NPPES record last updated: January 12, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 12, 2026, Jan 5, 2026 (2 updates tracked since 2026).

About Southside Community Health Services, Inc. NPPES

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

SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. (NPI 1376409276), doing business as Southside East Lake Street Dental Clinic, is a healthcare organization registered as a dentist in Minneapolis, Minnesota and active in the NPI registry since January 2026. The organization holds a CLIA Microscopy certificate valid through February 29, 2028 and lists Ann Cazaban, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1376409276
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameSOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Location Address1000 E LAKE STMinneapolis, MN 55407-1617
Mailing Address1000 E Lake StMinneapolis, MN 55407-1617 · (612) 822-9030 · Fax (612) 821-2818
Phone(612) 822-9030
Fax(612) 821-2818
Organization SubpartNo
Authorized OfficialAnn CazabanExecutive Director · (612) 827-7181
Enumeration DateJanuary 5, 2026
Last NPPES UpdateJanuary 12, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2026
✔ NPI 1376409276 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
1000 E LAKE ST, Minneapolis, MN 55407
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Other Names 1

Doing Business AsSouthside East Lake Street Dental Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 24D1043439

Southside Community Health Services · Minneapolis, MN
Active · expires Feb 29, 2028
CLIA Number24D1043439
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMarch 1, 2026
Certificate Expiration DateFebruary 29, 2028
Laboratory DirectorJunell M. Petersen
Laboratory Phone(612) 827-7181
Laboratory LocationSouthside Community Health Services1000 Est Lake Street, Minneapolis, MN 55407
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 4

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

MATTHEW JON STARK DDS
Dentist
1000 E LAKE ST
MINNEAPOLIS, MN 55407
Hennepin County (612) 821-2017
LAHIRI VILAS NAIKWAD
Dentist (General Practice)
1000 E LAKE ST
MINNEAPOLIS, MN 55407
Hennepin County (612) 827-7181
SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Clinic/Center (Federally Qualified Health Center (FQHC))
1000 E LAKE ST
MINNEAPOLIS, MN 55407
Hennepin County (612) 827-7181
SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Family Medicine
1000 E LAKE ST
MINNEAPOLIS, MN 55407
Hennepin County (612) 822-9030

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 Southside Community Health Services, Inc.'s NPI number?

The NPI number for Southside Community Health Services, Inc. is 1376409276. It was assigned to this organization in the NPPES registry on January 5, 2026. The provider is doing business as Southside East Lake Street Dental Clinic.

Where is Southside Community Health Services, Inc. located?

Southside Community Health Services, Inc. is located at 1000 E Lake St, Minneapolis, MN 55407. The listed phone number is (612) 822-9030.

What is Southside Community Health Services, Inc.'s specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Does Southside Community Health Services, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 24D1043439) is associated with this NPI, valid through February 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southside Community Health Services, Inc. was last updated on January 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.