Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Cedar Lake Community Clinic PA

Organization Dentist · NPI 1649582669

Cedar Lake Community Clinic PA is a Dentist in Minneapolis, Minnesota. Registered with an NPI since 2010.

In the registry since
2010
Specialties on file
3
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1831 E Lake St
Minneapolis, MN 55407-1809
Phone: (612) 276-1000
Fax: (612) 729-1885
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Dentist Taxonomy 122300000X
Internal Medicine Physician Taxonomy 207R00000X

Record details

NPI number1649582669
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kristen Coulter — President / Medical Director · (612) 276-1000
NPI enumeratedJuly 7, 2010
Last updated in NPPESFebruary 1, 2011
Mailing address1831 E Lake St, Minneapolis, MN 55407-1809

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