Amy Jean Kebriaei, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D12729 Issued in MN

Practice address

17510 Dodd Blvd
Lakeville, MN 55044

Phone

(952) 997-7100

Fax

(952) 997-2017

NPI assigned

Jul 10, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Amy Jean Haworth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childlren'S Dental Care LLC

  • Pediatric Dentistry
  • Lakeville, MN
  • NPI 1942436167
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247011200000",
    "number": "1104024264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17510 DODD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-997-7100",
            "fax_number": "952-997-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17510 DODD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-997-7100",
            "fax_number": "952-997-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBRIAEI",
        "first_name": "AMY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2009-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NE",
            "license": "6709",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D12729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "HAWORTH",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary E Justin, LPCC
• Theresa Marie Kaderlik
• Michael Brandt Kalinowski, D.O.
• Roma KC
• Selihom Filmon Kebede
• Jocelyn Kehr Sparby, LADC, LPCC
• Connie Keith
• Bradley Gene Keller, DPT
• Christine Keller, L.AC, DIPL.O.M.
• Courtney Sue Kellogg

• Pediatric Dentistry in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Pediatric Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.