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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

NPI # 1467508226
LBN Legal business name CENTRAL LAKES COMMUNITY DENTAL CLINIC
Authorized official LYNN GLANCEY - (CHIEF FINANCIAL OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/26/2007
Last updated 01/07/2026 - About 5 months ago
Identifiers
MN Medicaid 970826000
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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