Provider Demographics
NPI:1770315889
Name:CLD - EDEN PRAIRIE MN, LLC
Entity type:Organization
Organization Name:CLD - EDEN PRAIRIE MN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKSHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRESTHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:952-641-6228
Mailing Address - Street 1:964 PRAIRIE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7304
Mailing Address - Country:US
Mailing Address - Phone:651-444-9644
Mailing Address - Fax:
Practice Address - Street 1:964 PRAIRIE CENTER DR STE 230
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7304
Practice Address - Country:US
Practice Address - Phone:651-444-9644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental