Kelly Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KELLY FAMILY DENTISTRY

Practice address

2412 W Faidley Ave
Grand Island, NE 68803-4327

Phone

(308) 389-2811

Fax

(308) 389-2871

NPI assigned

Oct 8, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brad James Kelly, D.D.S.

Title

Owner/Dentist

Phone

(308) 389-2811

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1063764579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034327",
            "telephone_number": "308-389-2811",
            "fax_number": "308-389-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034327",
            "telephone_number": "308-389-2811",
            "fax_number": "308-389-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "308-389-2811",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keg Surgical Assisting, LLC
• Michael Keiser
• Rachel Keiser, APRN
• Jacquelyn Jean Keith
• Abbie Kelley, LPN
• Amber L. Kelly, D.D.S.
• Bradley J. Kelly, D.D.S.
• Brian K. Kelly, D.D.S.
• Kathryn Marie Kenna, M.D.
• Chelsey Loree Kennedy, DNP, WHNP-BC, IBCLC

• Dentist in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Dentist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.