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DR. KIMBERLY ELLEN ROSTVOLD DDS
NPI 1417479700
Dentist - Pediatric Dentistry in Hermantown, MN

Active since July 09, 2017PECOS Enrolled
4419 AIR BASE RD, HERMANTOWN, MN 55811(218) 728-2117 Get Directions Write a Review

NPPES record last updated: June 16, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 16, 2025, Jun 19, 2024, Oct 22, 2019 and 1 more (4 updates tracked since 2017).

About Dr. Kimberly Ellen Rostvold Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIMBERLY ELLEN ROSTVOLD DDS (NPI 1417479700) is an individual pediatric dentistry provider in Hermantown, Minnesota, licensed in Minnesota (D14233) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS and maintains 5 additional practice locations.

NPPES Registry Identity

NPI1417479700
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameDR. KIMBERLY ELLEN ROSTVOLDCredential: DDS
Location Address4419 AIR BASE RDHermantown, MN 55811-1847
Mailing Address3528 Holmes Ave SMinneapolis, MN 55408-3835 · (218) 256-8625
Phone(218) 728-2117
Sole ProprietorNo
Enumeration DateJuly 9, 2017
Last NPPES UpdateJune 16, 20254 updates tracked since enumeration
NPPES CertifiedJune 16, 2025
✔ NPI 1417479700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in MN · D14233
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Also ListedDentistTaxonomy 122300000X · License D14233 (MN), DS041402 (PA)
4419 AIR BASE RD, Hermantown, MN 55811
Open in Google Maps ↗

Secondary Practice Locations 5

Location 1357 S Gulph Rd Fl 1King Of Prussia, PA 19406-3136 · Phone (610) 337-2325 · Fax (610) 337-3863
Location 21315 E 24th StMinneapolis, MN 55404 · Phone (612) 721-9803
Location 31043 E US Highway 169Grand Rapids, MN 55744-3165 · Phone (218) 326-2560
Location 4715 S 8th StMinneapolis, MN 55404-7530 · Phone (612) 873-6010
Location 5701 Park AveMinneapolis, MN 55415-1623 · Phone (612) 873-3000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kimberly Ellen Rostvold Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55811 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ALLISON LEIGH ROBINSON DMD
Dentist (Pediatric Dentistry)
4419 AIR BASE RD
DULUTH, MN 55811
St. Louis County (218) 728-2117
DR. KELLY A PLOTE DDS
Dentist
4419 AIR BASE RD
HERMANTOWN, MN 55811
St. Louis County (218) 728-2117
ABBY PERSHKE JOHNSON DDS
Dentist (Pediatric Dentistry)
4419 AIR BASE RD
HERMANTOWN, MN 55811
St. Louis County (218) 728-2117
DR. HANNAH RUTTEN DDS
Dentist (Pediatric Dentistry)
4419 AIR BASE RD
HERMANTOWN, MN 55811
St. Louis County (218) 728-2117

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Rostvold's NPI number?

The NPI number for Kimberly Rostvold is 1417479700. It was assigned to this individual provider in the NPPES registry on July 9, 2017.

Where is Kimberly Rostvold located?

Kimberly Rostvold practices at 4419 Air Base Rd, Hermantown, MN 55811. The listed phone number is (218) 728-2117.

What is Kimberly Rostvold's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Kimberly Rostvold enrolled in Medicare?

Yes. Kimberly Rostvold is registered in the Medicare PECOS enrollment system.

What insurance does Kimberly Rostvold accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Florida Combined Life and Humana and 1 other insurer list Kimberly Rostvold as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kimberly Rostvold was last updated on June 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.