Kelsey Dierikx, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS-09677 Issued in IA

Practice address

2814 Northgate Dr Ste 2
Iowa City, IA 52245-9505

Phone

(319) 335-5484

Fax

(319) 338-9413

NPI assigned

Feb 5, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 14, 2023 through Jul 14, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral Surgery Assoc of Iowa City PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Iowa City, IA
  • NPI 1215034889
  NPD
• State University of Iowa

  • Clinical Medical Laboratory
  • Coralville, IA
  • NPI 1851371561
  NPD (past)

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1740745728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE BLDG S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-7440",
            "fax_number": "319-335-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2814 NORTHGATE DR STE 2",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522459505",
            "telephone_number": "319-335-5484",
            "fax_number": "319-338-9413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51300 Pomerantz Family Pavilion",
            "address_2": "200 Hawkins Dr",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421049",
            "country_code": "US",
            "telephone_number": "319-356-2205",
            "fax_number": "319-335-8956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Newton Rd",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421001",
            "country_code": "US",
            "telephone_number": "319-335-7440",
            "fax_number": "319-335-7451",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1804 E Washington St",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "IA",
            "postal_code": "526413217",
            "country_code": "US",
            "telephone_number": "319-385-5266",
            "fax_number": "319-385-9142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIERIKX",
        "first_name": "KELSEY",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-09677",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "DDS-09677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William A Dickinson III, MD
• Beverly Ann Dicorso
• Madisen Diehl, DDS
• Ryan John Diel, MD
• Kara R Dierikx, NNP-BC
• Alayna Elizabeth Dieter, MD
• Jenna Dietrich
• Megan M Dietzel, ARNP
• Lori D Dietzenbach Winborn, RD, LD
• Patricia Lee Differding, MSW, LISW

• Oral and Maxillofacial Surgery (Dentist) in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.