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Contact Information

CENTRAL LAKES COMMUNITY DENTAL CLINIC
11600 STATE AVE.
SUITE A
BRAINERD, MN56401
 Phone: 218-855-8600
 Fax: 651-431-7355
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for CENTRAL LAKES COMMUNITY DENTAL CLINIC · (Female)

NPI # 1467508226
Status Active
Credentials
Entity Individual
Enumeration date 01/26/2007
Last updated 01/07/2026 - About 5 months ago
Sole proprietor 1 Not specified
Identifiers
  • MN Medicaid 970826000
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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