Kelsey Birchem, DDS
Individual provider Active NPI Dentist · Dodge, NE
NPI 1659931301 · NPPES record last updated Apr 12, 2023
Key facts
- NPI
- 1659931301
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D11044 (OR)
- Practice address
- 445 2ND St
Dodge, NE 68633-3113 - Phone
- (402) 693-2285
- NPI assigned
- Jun 15, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210324000629 | NE | Practitioner - Dentist | 5496086480 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11044 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dodge Dental Office, P.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D11044 | OR | Yes |
Addresses
Primary practice location
445 2ND St
Dodge, NE 68633-3113
Mailing address
445 2ND St
Dodge, NE 68633-3113
Phone (402) 693-2285
Other names
- Kelsey Loontjer
Other providers in Dodge, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.