Organization
LAKE STREET DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE CAMARA GOOD D.D.S., M.S. (PERIOSONTIST)
(612) 724-1717
Entity
Organization
Contact information
Practice address
1508 E LAKE ST, MINNEAPOLIS, MN 55407-1720
(612) 724-1717
Mailing address
1508 E LAKE ST, MINNEAPOLIS, MN 55407-1720
(612) 724-1717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D11889
MN
1223P0300X
Periodontics
D11718
MN
1223P0700X
Prosthodontics
Primary
D12007
MN
Other
Enumeration date
06/16/2007
Last updated
09/11/2025
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