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Active NPI 1700456142 Individual Practitioner Male Practitioner

Dr. Kishore Vel Damodaran , DDS

Dentist - General Practice • Rochester, MN

Professional Overview & Biography Verified Profile Summary

Dr. Kishore Damodaran, DDS is a registered healthcare professional specializing in Dentist - General Practice in Rochester, MN. Practice services are available at 615 16TH ST SW under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

615 16th St Sw

Rochester, MN 559022103

Telephone 5072882539
Associated Practice Facility / Clinic
🏢 Rpm Group Facility NPI 1841846854

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Rochester, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
95 Specialists

Practicing in Rochester, MN (2262 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: 2025-05-20
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D14618

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Practice Associates & Co-Workers

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

2 Associated Practitioners
Dr. Duane Price , DDS

Dentist - General Practice

NPI 1528104239

Doctor of Dental Surgery

Dr. Keith Churchill , DDS

Dentist - General Practice

NPI 1558401505

Doctor of Dental Surgery

Career & Practice History Timeline

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

8 Historical Events
📍
Updated Practice Location May 20, 2025

Registered at 615 16TH ST SW, ROCHESTER, MN 559022103 (Tel: 5072882539)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 20, 2025

Dentist (License #D14618 in MN)

NPI Profile Active June 28, 2021

NPI status registered as active in NPPES database

📍
Updated Practice Location June 28, 2021

Registered at 2210 BROADWAY AVE N, ROCHESTER, MN 559064009 (Tel: 5072887379)

📍
Updated Business Mailing Address June 28, 2021

Registered at 225 BOARD CIR, MAHTOMEDI, MN 551151981 (Tel: 6512497305)

👤
Provider Name / Credentials Updated June 28, 2021

Recorded as KISHORE DAMODARAN, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 28, 2021

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration June 28, 2021

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: 1700456142
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 28, 2021
Last Update: May 20, 2025
Sole Proprietor: No

Mailing Address

225 Board Cir

Mahtomedi, MN 551151981

Phone: 6512497305

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.