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GREEN LAKE DENTAL
NPI 1841686359
Dentist - General Practice in Spicer, MN

Active since April 10, 2015
163 HIGHWAY 23 NE STE 1, SPICER, MN 56288(320) 796-2158(320) 409-1180 Get Directions Write a Review

NPPES record last updated: February 2, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 2, 2023, Feb 24, 2017 (2 updates tracked since 2017).

About Green Lake Dental NPPES

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

GREEN LAKE DENTAL (NPI 1841686359) is a healthcare organization registered as a general practice in Spicer, Minnesota and active in the NPI registry since April 2015. The organization lists Kirby Melvin Johnson, President, as its authorized official.

NPPES Registry Identity

NPI1841686359
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameKIRBY M. JOHNSON, D.D.S., LLC
Location Address163 HIGHWAY 23 NE STE 1Spicer, MN 56288-9735
Mailing Address163 Highway 23 Ne Ste 1Spicer, MN 56288-9735 · (320) 796-2158 · Fax (320) 409-1180
Phone(320) 796-2158
Fax(320) 409-1180
Organization SubpartNo
Authorized OfficialKirby Melvin JohnsonPresident · (320) 796-2158
Enumeration DateApril 10, 2015
Last NPPES UpdateFebruary 2, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 2, 2023
✔ NPI 1841686359 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

163 HIGHWAY 23 NE STE 1, Spicer, MN 56288
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Other Names 1

Doing Business AsGreen Lake Dental

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

Other Providers at the Same Location NPPES 2

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

DR. ZACHARY REIERSON DDS
Dentist (General Practice)
163 HIGHWAY 23 NE STE 1
SPICER, MN 56288
Kandiyohi County (320) 796-2158
DR. KIRBY MELVIN JOHNSON D.D.S.
Dentist (General Practice)
163 HIGHWAY 23 NE STE 1
SPICER, MN 56288
Kandiyohi County (320) 796-2158

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 Kirby M. Johnson, D.D.S., LLC's NPI number?

The NPI number for Kirby M. Johnson, D.D.S., LLC is 1841686359. It was assigned to this organization in the NPPES registry on April 10, 2015. The provider is doing business as Green Lake Dental.

Where is Kirby M. Johnson, D.D.S., LLC located?

Kirby M. Johnson, D.D.S., LLC is located at 163 Highway 23 NE Ste 1, Spicer, MN 56288. The listed phone number is (320) 796-2158.

What is Kirby M. Johnson, D.D.S., LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Kirby M. Johnson, D.D.S., LLC was last updated on February 2, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.