Kaitlyn Jean Niemann, RDH, DT

Primary specialty

Dental TherapistTaxonomy code 125J00000X

License

DT175 Issued in MN

Practice address

636 Broadway St NE
Minneapolis, MN 55413-2164

Phone

(612) 746-1530

NPI assigned

Apr 4, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Children'S Dental Services

  • Public Health Dentistry
  • Chisholm, MN
  • NPI 1669842662
  NPD (past)
• Childrens Dental Services Inc

  • Public Health Dentistry
  • Minneapolis, MN
  • NPI 1407973605
  NPD (past)

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1780436485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6478 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283716",
            "telephone_number": "612-875-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 BROADWAY ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554132164",
            "telephone_number": "612-746-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEMANN",
        "first_name": "KAITLYN",
        "middle_name": "JEAN",
        "credential": "RDH, DT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT175",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MN",
            "license": "11634",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Allis Nielsen, LICSW
• Madeleine B Nielsen
• Tad Nielsen
• Wendy Renae Nielsen, RD
• Moretta Nielson
• Alexander Niemczyk, MD
• Laura M Niemela, OTR/L
• Lucas Corby Niemeyer, MA, LPCC
• Melissa Niemiec
• Lainie Marie Niemyer, DPT

• Dental Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dental Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.