Timothy L Kelly DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D0505 Issued in SD

Legal business name

TIMOTHY L KELLY DDS

Doing business as

Rushmore Dental

Practice address

1600 Mountain View Rd
Suite 104
Rapid City, SD 57702-4381

Phone

(605) 430-9748

NPI assigned

Jan 19, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Lynn Kelly, DDS

Title

President

Phone

(605) 430-9748

Specialties & licenses 1

Addresses

Other names 1

• Rushmore Dental Doing business as

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

{
    "created_epoch": "1453161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1699132993",
    "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": "605-430-9748"
        },
        {
            "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": "605-430-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY L KELLY DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-19",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-430-9748",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SD",
            "license": "D0505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rushmore Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Norma Jo Tibbitts, R.N
• Patrick M Tibbles, MD
• Cooper Lee Timm, M.S.
• Kirsten Timmer, SLP
• Timothy James Hendeson
• Timothy L Kelly Dental Prof. LLC
• Anne Tingley, BA, ACT
• Kettie Ann Tisher-Farnam, LPC-MH
• Sammi Jo Tivis, D.C.
• TLC Home Care Services

• Dentist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Dentist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.

Verify at the official NPI Registry.