Dmitry Keysalov, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D11923 Issued in OR

Practice address

7017 SW Nyberg St
Tualatin, OR 97062-6243

Phone

(503) 612-8736

NPI assigned

Jan 17, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Tualatin Modern Dentistry,PC

  • General Practice Dentistry
  • Tualatin, OR
  • NPI 1437499852
  NPD (past)

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1841736634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6682 SW BRISBAND ST",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970706905",
            "telephone_number": "757-995-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7017 SW NYBERG ST",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970626243",
            "telephone_number": "503-612-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEYSALOV",
        "first_name": "DMITRY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-17",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy M Kelling, RN
• Jennifer Suzanne Kelly, MD
• Nathan Arthur Kemalyan, M.D.
• Eric Kendall, PT, DPT
• Patricia Kenney-Moore, MS, PA-C
• Vishal Khemlani, M.D.
• James A Kilgore, MD
• Mallory Kilmurray
• John Edmund Kilty, MD PHD
• Hannah Kim, DC, MSC

• Dentist in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.