THOMAS C. KELLEY DDS MSD LLC (NPI# 1780998997) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780998997 |
| Entity Type | Organization |
| Organization Name | THOMAS C. KELLEY DDS MSD LLC |
| Practice Address |
17280 W North Ave Ste 203 Brookfield WI 53045-4366 |
| Practice Telephone | 2627879075 |
| Practice Fax Number | 2627879076 |
| Mailing Telephone | 2627879075 |
| Mailing Fax Number | 2627879076 |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |
| Authorized Official Name | DR. THOMAS C KELLEY (PERIODONTIST) |
| Authorized Official Telephone | 2627879075 |
| Authorized Official Credential | DDS, MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
5257015 | WI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33778000 | 05 |
| Street Address |
17280 W NORTH AVE STE 203 |
| City | BROOKFIELD |
| State | WI |
| Zip Code | 53045-4366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801436159 | Jeannie Spoon | Behavioral Analyst | 200 N. Patrick Blvd. Ste 250, Brookfield, WI 53045 | 2020-01-14 |
| 1629635313 | Hallie Mackenzie Ritchay | Speech-Language Pathologist | Greenfield Rehabilitation Agency 19395 W Capitol Dr, Ste 200, Brookfield, WI 53045 | 2019-05-29 |
| 1427535038 | Kimberly Ann Beres | Registered Nurse | 2253 Norhardt Dr, Brookfield, WI 53045 | 2018-07-26 |
| 1265927768 | Brady Frederick Bachmann | Physical Therapist | 275 Regency Ct., Suite 200, Brookfield, WI 53045 | 2018-06-27 |
| 1841792603 | Wisconsin Renal Care Group, L.L.C. | Clinic/Center | 17500 W Capitol Drive, Brookfield, WI 53045 | 2018-03-07 |
| 1750828299 | Nanette Marie Kloth | Nurse Practitioner | 18110 W Bluemond Rd, Brookfield, WI 53045 | 2017-01-23 |
| 1144772013 | Saida Reifenrath | Acupuncturist | 240 Regency Court, Suite 102, Brookfield, WI 53045 | 2016-10-26 |
| 1437545951 | Kylee Stevenson | Chiropractor | 19555 W Bluemound Rd Ste 6, Brookfield, WI 53045 | 2015-04-10 |
| 1548659725 | Patricia Ann Kender | Nurse Practitioner | 17495 W. Capitol Dr., Brookfield, WI 53045 | 2015-01-12 |
| 1568882793 | Kassandra E Holzem | Dermatology | 195 Discovery Dr, Brookfield, WI 53045 | 2014-04-28 |
| Find all providers in zip 53045 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770572828 | Thomas Christopher Kelley | Dentist | 150 S Calhoun Rd, Brookfield, WI 53005-6303 | 2005-10-20 |
| 1982729158 | The Dental Team | Dentist | 109 Federal Road, Brookfield, CT 06804 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235683830 | Phillip Crum | Dentist | 2581 Development Dr Ste 204, Bellevue, WI 54311-4248 | 2016-08-11 |
| 1285937557 | Craig William Byers | Dentist | 2457 North Mayfair Road, Suite 102, Wauwatosa, WI 53226-1405 | 2010-12-08 |
| 1558662387 | Jason William Cooke | Dentist | 2557b E Calumet St, Appleton, WI 54915-4748 | 2010-11-10 |
| 1376789933 | Shoreline Periodontics Limited | Dentist | 2808 Kohler Memorial Dr, Suite 2, Sheboygan, WI 53081-3177 | 2008-12-31 |
| 1003052895 | James P. Herman | Dentist | 5624 S Bonnie Ln, Hales Corners, WI 53130-1674 | 2008-12-28 |
| 1760684930 | Jeffrey Joseph Burke | Dentist | 2323 S 109th St Ste 275, West Allis, WI 53227-1912 | 2007-06-01 |
| 1992915276 | Scott George Metskas | Dentist | 3364 Iris Ln, Stevens Point, WI 54481-5618 | 2007-05-23 |
| 1134339500 | Fox River Periodontics Sc | Dentist | 2557b East Calumet St, Appleton, WI 54915 | 2007-05-23 |
| 1891903043 | Denise Y Shih | Dentist | 2853 N Marietta Ave, Milwaukee, WI 53211-3420 | 2007-05-20 |
| 1629280987 | Nancy Ellen Shumate | Dentist | 2600 N Mayfair Rd Ste 340, Wauwatosa, WI 53226-1372 | 2007-05-07 |
| Find all providers with the same taxonomy | ||||
| City | BROOKFIELD |
| Zip Code | 53045 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.