Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
LAKE AREA DENTAL
Active
Organization
LAKE AREA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN DITTBERNER DDS (DENTIST)
(651) 308-1177
Entity
Organization
Contact information
Practice address
4801 HIGHWAY 61 N STE 301, WHITE BEAR LAKE, MN 55110-2753
(651) 762-8474
Mailing address
140 WILDWOOD CT, MAHTOMEDI, MN 55115-4200
(651) 308-1177
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/05/2024
Last updated
12/05/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up