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

Lake Street Family Dental PA

Organization Dentist · NPI 1083096085

Lake Street Family Dental PA is a Dentist in Mora, Minnesota. Licensed in Minnesota. Registered with an NPI since 2015.

Licensed in
MN
In the registry since
2015
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

119 Lake St S Ste 1
Mora, MN 55051-1576
Phone: (320) 679-2435
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D13567 (MN)

Record details

NPI number1083096085
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Steven Holcombe — President · (763) 350-6234
NPI enumeratedJune 25, 2015
Last updated in NPPESJune 25, 2015
Mailing address10799 251st Ave Nw, Zimmerman, MN 55398-4558

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