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

Lake Street Dental

Organization General Practice Dentistry · NPI 1184829509

Lake Street Dental is a General Practice Dentistry in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2007.

Licensed in
MN
In the registry since
2007
Specialties on file
3

Practice location Address checks out

1508 E Lake St
Minneapolis, MN 55407-1720
Phone: (612) 724-1717
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Prosthodontics (primary) Taxonomy 1223P0700X · Licence D12007 (MN)
General Practice Dentistry Taxonomy 1223G0001X · Licence D11889 (MN)
Periodontics Taxonomy 1223P0300X · Licence D11718 (MN)

Record details

NPI number1184829509
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Renee Good — Periosontist · (612) 724-1717
NPI enumeratedJune 16, 2007
Last updated in NPPESSeptember 11, 2025
Mailing address1508 E Lake St, Minneapolis, MN 55407-1720

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