Active NPI
Kelley A. Gyllenhaal, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Minneapolis, MN
National Provider Identifier
1346672060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- R578
- Practice address
- 515 Delaware St SE
6-320
Minneapolis, MN 55455-0357 - Phone
- (612) 625-5110
- NPI assigned
- Aug 5, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | R578 | MN | Primary |
Addresses
Primary practice location
515 Delaware St SE
6-320
Minneapolis, MN 55455-0357
Mailing address
1080 Shermer Rd
Glenview, IL 60025-2730
Phone (847) 404-5657
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
| License | State | Type | Specialty |
|---|---|---|---|
| R578 | MN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1346672060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1080 SHERMER RD",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600252730",
"telephone_number": "847-404-5657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 DELAWARE ST SE",
"address_2": "6-320",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550357",
"telephone_number": "612-625-5110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GYLLENHAAL",
"first_name": "KELLEY",
"middle_name": "A.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-05",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MN",
"license": "R578",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.