Active NPI
Timothy Lynn Kelly, DDS
- Dentist
- Rapid City, SD
National Provider Identifier
1588653281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D0505
- Practice address
- 1600 Mountain View Rd
Suite 104
Rapid City, SD 57702-4381 - Phone
- (605) 593-0037
- Fax
- (605) 593-8351
- NPI assigned
- Oct 17, 2005
- Last updated
- Mar 17, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D0505 | SD | Primary |
Addresses
Primary practice location
1600 Mountain View Rd
Suite 104
Rapid City, SD 57702-4381
Mailing address
1600 Mountain View Rd
Suite 104
Rapid City, SD 57702-4381
Phone (605) 593-0037
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0505 | SD | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas Erick Benjamin, LLC | Current | Accepting new patients | |
| Modern Dental Professionals, MN PC | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- General Practice Dentistry
- Rapid City, SD
- NPI 1568201150
-
dba Midwest Dental
- General Practice Dentistry
- Worthington, MN
- NPI 1144513565
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458172800000",
"number": "1588653281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 MOUNTAIN VIEW RD",
"address_2": "SUITE 104",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577024381",
"telephone_number": "605-593-0037",
"fax_number": "605-593-8351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 MOUNTAIN VIEW RD",
"address_2": "SUITE 104",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577024381",
"telephone_number": "605-593-0037",
"fax_number": "605-593-8351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TIMOTHY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2016-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SD",
"license": "D0505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.