TIMOTHY L KELLY DENTAL PROF. LLC (NPI# 1710433123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710433123 |
| Entity Type | Organization |
| Organization Name | TIMOTHY L KELLY DENTAL PROF. LLC |
| Other Organization Name | RUSHMORE DENTAL |
| Practice Address |
1600 Mountain View Rd Ste 104 Rapid City SD 57702-4354 |
| Practice Telephone | 6055930037 |
| Practice Fax Number | 6055938351 |
| Mailing Telephone | 6055930037 |
| Mailing Fax Number | 6055938351 |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2016-08-27 |
| Authorized Official Name | DR. TIMOTHY LYNN KELLY (OWNER) |
| Authorized Official Telephone | 6055930037 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D0505 | SD | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | 1588653281 | 05 |
| Other Name | Type Code |
|---|---|
| Rushmore Dental | Doing Business As Name - Organization |
| Street Address |
1600 MOUNTAIN VIEW RD STE 104 |
| City | RAPID CITY |
| State | SD |
| Zip Code | 57702-4354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366049660 | Byrne Dental, Professional LLC | Dentist | 3825 Canyon Lake Dr, Rapid City, SD 57702 | 2020-10-08 |
| 1427603026 | Mikaela Licht | Technician | 4310 Cedar Ridge Pl. Apt #5, Rapid City, SD 57702 | 2019-08-09 |
| 1932761335 | Great Plains Tribal Chairmen's Health Board | Pharmacy | Oyate Health Center, 3200 Canyon Lake Drive, Rapid City, SD 57702 | 2019-07-05 |
| 1598231334 | Regional Health Physicians, Inc. | Clinic/Center | 1635 Caregiver Circle, Rapid City, SD 57702 | 2018-10-19 |
| 1851813224 | Angie Deneire | Licensed Practical Nurse | 7312 Pinon Jay Circle, Rapid City, SD 57702 | 2017-07-07 |
| 1073063830 | Kirsten William-kennedy Dds, Ms, P.C. | Dentist | 740 Sheridan Lk. Rd. Suite A, Rapid City, SD 57702 | 2016-10-05 |
| 1932558939 | Emily T Rausch | Physical Therapist | 2040 West Main, #212, Rapid City, SD 57702 | 2016-06-09 |
| 1033597810 | John Dennis Burke | Speech-Language Pathologist | 4635 Wentworth Drive, Rapid City, SD 57702 | 2015-05-12 |
| 1013394535 | Dakota Regional Periodontics | Dentist | 2800 Jackson Blvd #6, Rapid City, SD 57702 | 2015-05-05 |
| 1306272414 | Lindsy Jo Wathen | Speech-Language Pathologist | 13232 Klondike Road, Rapid City, SD 57702 | 2013-09-20 |
| Find all providers in zip 57702 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992225239 | Kelsey Elizabeth Wondercheck | Dentist | 717 Meade Street, Suite 200, Rapid City, SD 57701 | 2017-06-27 |
| 1073063830 | Kirsten William-kennedy Dds, Ms, P.C. | Dentist | 740 Sheridan Lk. Rd. Suite A, Rapid City, SD 57702 | 2016-10-05 |
| 1801270228 | Michael Doerr | Dentist | 801 Mount Rushmore Rd Ste 201, Rapid City, SD 57701-3614 | 2015-07-15 |
| 1013183821 | Kelly Lytle | Dentist | 3312 Jackson Blvd, Rapid City, SD 57702-3346 | 2008-05-01 |
| 1952593360 | Jennifer Leah Hendricks Friedman | Dentist | 2800 Jackson Blvd Ste 9, Rapid City, SD 57702-3477 | 2007-08-10 |
| 1336209808 | Paul M. Rezich, Dds, PC | Dentist | 503 E North St, Rapid City, SD 57701-1462 | 2006-12-12 |
| 1144392440 | Jeffrey T Bloom | Dentist | 631 St Anne St, Suite 105, Rapid City, SD 57701 | 2006-11-14 |
| 1336250687 | Mary Kay Roth | Dentist | 807 St Andrew, Rapid City, SD 57701-4526 | 2006-08-31 |
| 1871606202 | Joseph M Lytle | Dentist | 710 Mt Rushmore Rd, Rapid City, SD 57701 | 2006-08-17 |
| 1326056086 | Carl R Stonecipher | Dentist | 2800 Jackson Blvd, Suite 9, Rapid City, SD 57702 | 2006-08-04 |
| Find all providers in RAPID CITY | ||||
| City | RAPID CITY |
| Zip Code | 57702 |
Please comment or provide details below to improve the information on TIMOTHY L KELLY DENTAL PROF. LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.