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 provides 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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