Active NPI
Brian Patrick Kelley, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Waukesha, WI
National Provider Identifier
1366423527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 5197-015
- Practice address
- W230S4497 Milky Way Road
Waukesha, WI 53189 - Phone
- (262) 312-8384
- NPI assigned
- Nov 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 5197-015 | WI | Primary |
Addresses
Primary practice location
W230S4497 Milky Way Road
Waukesha, WI 53189
Mailing address
W230S4497 Milky Way Road
Waukesha, WI 53189
Phone (262) 312-8384
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 397627370000 | Other | WI | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5197-015 | WI | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740096000000",
"number": "1366423527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W230S4497 MILKY WAY ROAD",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "53189",
"telephone_number": "262-312-8384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W230S4497 MILKY WAY ROAD",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "53189",
"telephone_number": "262-312-8384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "BRIAN",
"middle_name": "PATRICK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2025-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "WI",
"license": "5197-015",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "397627370000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.