Active NPI
Keelen Tymkiw, BDS
- Periodontics
- Iowa City, IA
National Provider Identifier
1740485598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 30200
- Practice address
- University of Iowa, College of Dentistry, Periodontics
S450 DSB
Iowa City, IA 52242 - Phone
- (319) 335-7238
- NPI assigned
- Jun 20, 2007
- Last updated
- Mar 7, 2023
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 30200 | IA | Primary |
Addresses
Primary practice location
University of Iowa, College of Dentistry, Periodontics
S450 DSB
Iowa City, IA 52242
Mailing address
2206 Holiday Rd
Coralville, IA 52241-2743
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30200 | Other | IA | IOWA BOARD OF DENTAL EXAM |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30200 | IA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1740485598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2206 HOLIDAY RD",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522412743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UNIVERSITY OF IOWA, COLLEGE OF DENTISTRY, PERIODONTICS",
"address_2": "S450 DSB",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "52242",
"telephone_number": "319-335-7238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYMKIW",
"first_name": "KEELEN",
"name_prefix": "Dr.",
"credential": "BDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-20",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IA",
"license": "30200",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IOWA BOARD OF DENTAL EXAM",
"identifier": "30200",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.