Active NPI
Kayla Jo Dejong, DDS
- Dentist
- Rapid City, SD
National Provider Identifier
1083355101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D1357
- Practice address
- 5610 Bendt Dr
Rapid City, SD 57702-9534 - Phone
- (605) 342-5995
- NPI assigned
- Apr 5, 2022
- Last updated
- Jun 9, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D1357 | SD | Primary |
Addresses
Primary practice location
5610 Bendt Dr
Rapid City, SD 57702-9534
Mailing address
931 9TH Ave NE
Watertown, SD 57201-1819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1357 | SD | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carpenter Dental , PLLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Rapid City, SD
- NPI 1730904368
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1083355101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 9TH AVE NE",
"city": "WATERTOWN",
"state": "SD",
"postal_code": "572011819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5610 BENDT DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577029534",
"telephone_number": "605-342-5995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJONG",
"first_name": "KAYLA",
"middle_name": "JO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2022-06-09",
"certification_date": "2022-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SD",
"license": "D1357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.