Emily Schmalz Kelly, D.D.S, M.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D12773 Issued in MN

Practice address

3142 Wellner Dr NE
Implant and Periodontal Professionals
Rochester, MN 55906-8388

Phone

(507) 206-6452

NPI assigned

Jun 19, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 26, 2021 through Mar 26, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1245467075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3142 WELLNER DR NE",
            "address_2": "IMPLANT AND PERIODONTAL PROFESSIONALS",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559068388",
            "telephone_number": "507-206-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 WELLNER DR NE",
            "address_2": "IMPLANT AND PERIODONTAL PROFESSIONALS",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559068388",
            "telephone_number": "507-206-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "EMILY",
        "middle_name": "SCHMALZ",
        "name_prefix": "Dr.",
        "credential": "D.D.S, M.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-19",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D12773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camry Lynn Kelly, DO
• Casey Kimberly Kelly, MD
• Cecilia Kelly
• Daniel Kelly, M.B, B.CH, BAO
• Ellen Kelly, M.B., B.CH., B.A.O
• Frank Andrew Kelly, DO
• Gina D Kelly, MT-BC
• Jacqueline Kelly, PT
• Laura Irene Kelly, DMD
• Michael Robert Kelly, MD

• Periodontics in Rochester, MN
• Providers in Rochester, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.