Active NPI
Kyle Stephen Novotny, DDS
- General Practice Dentistry
- Blaine, MN
National Provider Identifier
1437767555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D14428
- Practice address
- 12265 Central Ave NE
Blaine, MN 55434-3961 - Phone
- (763) 757-1323
- NPI assigned
- Jul 14, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D14428 | MN | Primary |
Addresses
Primary practice location
12265 Central Ave NE
Blaine, MN 55434-3961
Mailing address
12265 Central Ave NE
Blaine, MN 55434-3961
Phone (763) 757-1323
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 |
|---|---|---|---|
| D14428 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kyle Novotny DDS PLLC | General Practice | Current | Accepting new patients |
Locations
12265 Central Ave NE
Minneapolis, MN 55434
Phone (763) 757-1323
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1437767555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12265 CENTRAL AVE NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554343961",
"telephone_number": "763-757-1323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12265 CENTRAL AVE NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554343961",
"telephone_number": "763-757-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVOTNY",
"first_name": "KYLE",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-14",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D14428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.