NPIMap

Organization Active NPI

Implant and Periodontal Professionals

  • Periodontics
  • Rochester, MN
National Provider Identifier
1306236708
Registry record updated Jan 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
D12773 Issued in MN
Legal business name
IMPLANT AND PERIODONTAL PROFESSIONALS
Practice address
3142 Wellner Dr NE
Rochester, MN 55906-8388
Phone
(507) 206-6452
Fax
(507) 206-6186
NPI assigned
Jan 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2016

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

Authorized official

Name
Dr. Emily Schmalz Kelly, DDS, MS
Title
Periodontitist
Phone
(651) 261-3644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X D12773 MN Primary

Addresses

Primary practice location

3142 Wellner Dr NE
Rochester, MN 55906-8388

Mailing address

3142 Wellner Dr NE
Rochester, MN 55906-8388
Phone (507) 206-6452

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452211200000",
    "number": "1306236708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3142 WELLNER DR NE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559068388",
            "telephone_number": "507-206-6452",
            "fax_number": "507-206-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3142 WELLNER DR NE",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559068388",
            "telephone_number": "507-206-6452",
            "fax_number": "507-206-6186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPLANT AND PERIODONTAL PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-23",
        "last_updated": "2016-01-08",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "SCHMALZ",
        "authorized_official_title_or_position": "PERIODONTITIST",
        "authorized_official_telephone_number": "651-261-3644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D12773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; 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.