Rolla Family Dentistry Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

015882 Issued in MO

Legal business name

ROLLA FAMILY DENTISTRY INC

Practice address

1701 E 10TH St
Rolla, MO 65401-4601

Phone

(573) 364-1599

NPI assigned

Oct 10, 2014

Organization subpart

No

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

Authorized official

Name

Jeremy Kiersz, DDS

Title

Owner/President

Phone

(573) 364-1599

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1154725745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014601",
            "telephone_number": "573-364-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLLA FAMILY DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "KIERSZ",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "573-364-1599",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "015882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kathleen Robinson-Black, L.P.C.
• Shannon Liane Robinson, M.D.
• Cathleen E Rodriguez, LPC
• Rolla Children'S Clinic, P.C.
• Rolla Dermatology LLC
• Rolla Grand LLC
• Rolla Health Care LLC
• Rolla Manor, Inc.
• Rolla Neurology, Pain & Sleep, LLC
• Rolla Ophthalmology Associates, Inc

• General Practice Dentistry in Rolla, MO
• Providers in Rolla, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; 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.