Timothy L Kelly Dental Prof. LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D0505 Issued in SD

Legal business name

TIMOTHY L KELLY DENTAL PROF. LLC

Doing business as

Rushmore Dental

Practice address

1600 Mountain View Rd Ste 104
Rapid City, SD 57702-4354

Phone

(605) 593-0037

Fax

(605) 593-8351

NPI assigned

Aug 27, 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

Owner

Phone

(605) 593-0037

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Rushmore Dental Doing business as

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

{
    "created_epoch": "1472256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472256000000",
    "number": "1710433123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 MOUNTAIN VIEW RD STE 104",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577024354",
            "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 STE 104",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577024354",
            "telephone_number": "605-593-0037",
            "fax_number": "605-593-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY L KELLY DENTAL PROF. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-27",
        "last_updated": "2016-08-27",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-593-0037",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588653281",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rushmore Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• 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 Aug 27, 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.