DR. KELLY RAE MOORE DDS
NPI 1790277416
Dentist in Mound, MN

Q: What is Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1790277416. It was assigned to this individual provider in the NPPES registry on May 30, 2018.

Q: What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Moore was last updated on April 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.

Active since May 30, 2018

5205 SHORELINE DR, MOUND, MN 55364(952) 831-2800 Get Directions Write a Review

NPPES record last updated: April 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 10, 2025, Apr 3, 2025, Oct 14, 2019 and 1 more (4 updates tracked since 2018).

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About Dr. Kelly Rae Moore Dds NPPES

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

DR. KELLY RAE MOORE DDS (NPI 1790277416) is an individual dentist in Mound, Minnesota, licensed in Minnesota (D14010) and active in the NPI registry since May 2018. She maintains a secondary practice location in Chaska.

NPPES Registry Identity

NPI1790277416

Entity TypeIndividualFemale

Primary Taxonomy122300000X

Provider Legal NameDR. KELLY RAE MOORECredential: DDS

Location Address5205 SHORELINE DRMound, MN 55364-1770

Mailing Address5205 Shoreline DrMound, MN 55364-1770 · (952) 260-6770

Phone(952) 831-2800

Sole ProprietorNo

Enumeration DateMay 30, 2018

Last NPPES UpdateApril 10, 20254 updates tracked since enumeration

NPPES CertifiedApril 10, 2025

✔ NPI 1790277416 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in MN · D14010

Definition

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.

5205 SHORELINE DR, Mound, MN 55364

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Secondary Practice Location 1

Location 1132 Pioneer TrlChaska, MN 55318-1167 · Phone (952) 900-4354

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 ›

Other Providers at the Same Location NPPES 2

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

DR. REILLY LYNN KROISS DDS

Dentist (General Practice)

5205 SHORELINE DR
MOUND, MN 55364

Hennepin County (952) 472-7717

WEST LAKES DENTISTRY, PA

Dentist (Oral and Maxillofacial Surgery)

5205 SHORELINE DR
MOUND, MN 55364

Hennepin County (952) 472-7717

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 Kelly Moore's NPI number?

The NPI number for Kelly Moore is 1790277416. It was assigned to this individual provider in the NPPES registry on May 30, 2018.

Where is Kelly Moore located?

Kelly Moore practices at 5205 Shoreline Dr, Mound, MN 55364. The listed phone number is (952) 831-2800.

What is Kelly Moore's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Kelly Moore 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, Humana and Renaissance Dental list Kelly Moore 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 Kelly Moore was last updated on April 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.