TC Orthodontics Red Wing

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

11493 Issued in MN

Legal business name

TC ORTHODONTICS RED WING

Practice address

615 W 4TH St
Red Wing, MN 55066-2413

Phone

(651) 388-8851

NPI assigned

Jan 7, 2013

Last updated

Jan 7, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Chad Holly Kelly, D.M.D.

Title

President

Phone

(763) 420-1030

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1467799866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W 4TH ST",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662413",
            "telephone_number": "651-388-8851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W 4TH ST",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662413",
            "telephone_number": "651-388-8851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TC ORTHODONTICS RED WING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "HOLLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-420-1030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "11493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.

Verify at the official NPI Registry.