Individual provider Active NPI

Mariah Rose Kemmer

  • Dental Hygienist
  • Park Rapids, MN
National Provider Identifier
1164800322
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
H9565 Issued in MN
Practice address
19033 US 71
Park Rapids, MN 56470-3202
Phone
(218) 732-3291
NPI assigned
May 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X H9565 MN Primary

Addresses

Primary practice location

19033 US 71
Park Rapids, MN 56470-3202

Mailing address

19033 US 71
Park Rapids, MN 56470-3202
Phone (218) 732-3291

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

LicenseStateTypeSpecialty
H9565MNMDDental Hygienist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Rapids Family Dental PLLC PastSince Apr 19, 2020 Accepting new patients
David E Andersen DDS PA Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1164800322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19033 US 71",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564703202",
            "telephone_number": "218-732-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19033 US 71",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564703202",
            "telephone_number": "218-732-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEMMER",
        "first_name": "MARIAH",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MN",
            "license": "H9565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; 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.