John M Kelley Jr., JOHN KELLEY, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

TX19132 Issued in TX

Practice address

1533 Merrimac Cir
Suite 207
Fort Worth, TX 76107-6571

Phone

(817) 338-0771

Fax

(817) 332-8072

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437378965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 MERRIMAC CIR",
            "address_2": "SUITE 207",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076571",
            "telephone_number": "817-338-0771",
            "fax_number": "817-332-8072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1533 MERRIMAC CIR",
            "address_2": "SUITE 207",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076571",
            "telephone_number": "817-338-0771",
            "fax_number": "817-332-8072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_suffix": "Jr.",
        "credential": "JOHN KELLEY, DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "TX19132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Marie Kelley, PT, DPT
• Daniel Kelley, MD
• Gordan Kelley, LMSW-ACP
• James Joseph Kelley IV, D.O.
• Jeffrey Adam Kelley Sr., DDS
• Larry Kelley
• Ryan Kelley
• Sarah Louise Kelley, RN
• Suzanne B Kelley, MD
• Trent Kelley

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.