Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1790277416 Individual Practitioner Female Practitioner

Dr. Kelly Rae Moore , DDS

Dentist • Mound, MN

Professional Overview & Biography Verified Profile Summary

Dr. Kelly Moore, DDS is a registered healthcare professional specializing in Dentist in Mound, MN. Practice services are available at 5205 SHORELINE DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

5205 Shoreline Dr

Mound, MN 553641770

Telephone 9528312800
Associated Practice Facility / Clinic
🏢 West Lakes Dentistry, Pa Facility NPI 1497113674

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Mound, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.6 Yrs
Regional Practice Density
3 Specialists

Practicing in Mound, MN (1863 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-04-10
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License MN D14010

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Secondary Practice Locations

132 Pioneer Trl

Chaska, MN 553181167

Phone: 9529004354

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
NPI 1043383797

Doctor of Dental Surgery

NPI 1386717049

Doctor of Dental Surgery

NPI 1457424103

Doctor of Dental Surgery

NPI 1508939240

Doctor of Dental Surgery

NPI 1619953320

Doctor of Dental Surgery

NPI 1790858447

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location April 10, 2025

Registered at 5205 SHORELINE DR, MOUND, MN 553641770 (Tel: 9528312800)

📍
Updated Business Mailing Address April 10, 2025

Registered at 5205 SHORELINE DR, MOUND, MN 553641770 (Tel: 9522606770)

👤
Provider Name / Credentials Updated April 10, 2025

Recorded as KELLY MOORE, DDS

📍
Updated Practice Location June 15, 2022

Registered at 7373 FRANCE AVE S STE 500, EDINA, MN 554354551 (Tel: 9528312800)

📍
Updated Business Mailing Address June 15, 2022

Registered at 7373 FRANCE AVE S STE 500, EDINA, MN 554354551 (Tel: 9528312800)

📍
Updated Practice Location October 14, 2019

Registered at 14475 FOREST BLVD N, HUGO, MN 550387461 (Tel: 6514268088)

📍
Updated Business Mailing Address October 14, 2019

Registered at 14475 FOREST BLVD N, HUGO, MN 550387461 (Tel: 6514268088)

NPI Profile Active June 11, 2018

NPI status registered as active in NPPES database

📍
Updated Practice Location June 11, 2018

Registered at 1 VETERANS DR # 2U-122, MINNEAPOLIS, MN 55417 (Tel: 6124672039)

📍
Updated Business Mailing Address June 11, 2018

Registered at 1 VETERANS DR RM 2U-122, MINNEAPOLIS, MN 554172309 (Tel: 6124672039)

👤
Provider Name / Credentials Updated June 11, 2018

Recorded as KELLY DJERF, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 11, 2018

Dentist (License #D14010 in MN)

🟢
Initial NPI Registration & Enumeration May 30, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1790277416
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 30, 2018
Last Update: April 10, 2025
Sole Proprietor: No

Mailing Address

5205 Shoreline Dr

Mound, MN 553641770

Phone: 9522606770

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.