Kelly K Koehnen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10985 Issued in MN

Practice address

1406 W Lake St
Ste 100
Minneapolis, MN 55408-2653

Phone

(612) 827-3736

Fax

(612) 821-9626

NPI assigned

Jun 20, 2005

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Uptown Dental Acquisition Company

  • General Practice Dentistry
  • Minneapolis, MN
  • NPI 1659458974
  NPD (past)

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1285639815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 W LAKE ST",
            "address_2": "STE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082653",
            "telephone_number": "612-827-3736",
            "fax_number": "612-821-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 W LAKE ST",
            "address_2": "STE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082653",
            "telephone_number": "612-827-3736",
            "fax_number": "612-821-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEHNEN",
        "first_name": "KELLY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kent Kodalen, PH.D.
• Molly Kodl, PHD
• Jennifer Koehn, MSW
• Kate Zelic Koehn, PHD
• Jessica Taylor Koehnen
• Robert Joseph Koelbl, RPH
• Timothy J Koelz, M.D.
• Renee Diane Koemptgen, CNS
• Kenneth S Koeneman, MD
• Alexander Josip Koenig, DDS

• General Practice Dentistry in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.