Kiersten Micael Boehm Masello, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14422 Issued in MN

Practice address

14199 Edgewood Dr
Baxter, MN 56425-8462

Phone

(651) 587-6846

NPI assigned

Apr 4, 2020

Last updated

Jul 15, 2020By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kiersten Masello DDS PLLC

  dba Crosslake Dental Center, PA

  • Dental Clinic/Center
  • Crosslake, MN
  • NPI 1518614205
  NPD Authorized official

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

{
    "created_epoch": "1585958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1922637636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2523 MAPLE LN",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131013",
            "telephone_number": "651-587-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14199 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258462",
            "telephone_number": "651-587-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASELLO",
        "first_name": "KIERSTEN",
        "middle_name": "MICAEL BOEHM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-04",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Therese Manecke, PA
• Philip Manger, MD
• Lindsay Martin
• Sheila Elizabeth Martin
• Lora C Martinson, DPT
• Jerome Mauro
• Jacqueline M McCall, OD
• Kelly Ann McKenzie
• Francis Xavier McLaughlin, MSW LICSW
• Alex McLean, DC

• Dentist in Baxter, MN
• Providers in Baxter, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; 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.