NPIMap

Organization Active NPI

South Des Moines Dental

Doing business as South Des Moines Dental Practice

  • Dental Clinic/Center
  • Des Moines, IA
National Provider Identifier
1861106700
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SOUTH DES MOINES DENTAL
Doing business as
South Des Moines Dental Practice
Practice address
4401 SW 9TH St
Des Moines, IA 50315-3909
Phone
(515) 285-9962
NPI assigned
Jan 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Authorized official

Name
Dr. Kyle J Connolly, DDSNPI 1134268055
Title
Owner Dentist
Phone
(515) 285-9962

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4401 SW 9TH St
Des Moines, IA 50315-3909

Mailing address

4401 SW 9TH St
Des Moines, IA 50315-3909
Phone (515) 285-9962

Other names 1

  • South Des Moines Dental Practice Doing business as

National Provider Directory

National Provider Directory

Locations

4401 SW 9th St
Des Moines, IA 50315
Phone (515) 285-9962

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1861106700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503153909",
            "telephone_number": "515-285-9962",
            "fax_number": "515-285-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503153909",
            "telephone_number": "515-285-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH DES MOINES DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "CONNOLLY",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "515-285-9962",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Des Moines Dental Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.

Verify at the official NPI Registry.