Kimberly Ellen Rostvold, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D14233 Issued in MN

Practice address

4419 Air Base Rd
Hermantown, MN 55811-1847

Phone

(218) 728-2117

NPI assigned

Jul 9, 2017

Last updated

Jun 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hennepin Healthcare System, Inc

  dba Hennepin County Medical Center

  • Rehabilitation Hospital Unit
  • Minneapolis, MN
  • NPI 1033138136
  Medicare reassignment NPD
• Hennepin Healthcare System Inc

  dba HCMC Specialty Services Pharmacy

  • Specialty Pharmacy
  • Minneapolis, MN
  • NPI 1619567625
  NPD
• Hennepin Healthcare System, Inc

  dba Hennepin County Medical Center

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1407897309
  NPD
• James Rostvold

  dba West Range Dental Care

  • General Practice Dentistry
  • Grand Rapids, MN
  • NPI 1205584307
  NPD
• West Range Dental PLLC

  • Dental Clinic/Center
  • Grand Rapids, MN
  • NPI 1437978004
  NPD
• Eversmiles Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Hermantown, MN
  • NPI 1285873687
  NPD (past)

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

{
    "created_epoch": "1499558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1417479700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3528 HOLMES AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083835",
            "telephone_number": "218-256-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 AIR BASE RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111847",
            "telephone_number": "218-728-2117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "357 S Gulph Rd Fl 1",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194063136",
            "country_code": "US",
            "telephone_number": "610-337-2325",
            "fax_number": "610-337-3863",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 E 24th St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55404",
            "country_code": "US",
            "telephone_number": "612-721-9803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "715 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554047530",
            "country_code": "US",
            "telephone_number": "612-873-6010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1043 E US Highway 169",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MN",
            "postal_code": "557443165",
            "country_code": "US",
            "telephone_number": "218-326-2560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSTVOLD",
        "first_name": "KIMBERLY",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-09",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14233",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS041402",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D14233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Payton Jacqueline Reppe
• Jennifer Rickoff
• Maria Lauren Roberts
• Taylor Rose Rohow
• Romano LLC (Guiding Light Wellness)
• Hannah Rudeck
• Nicholas Martin Ruigh
• Hannah Rutten, DDS
• Sara Leeann Saari
• Hannah Sagaitis

• Pediatric Dentistry in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Pediatric Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.