Paul John Kelly, DDS, MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D6913 Issued in AZ

Practice address

726 N Greenfield Rd
Suite 117
Gilbert, AZ 85234-5061

Phone

(480) 685-9696

Fax

(480) 378-3565

NPI assigned

May 17, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 7, 2017 through Feb 7, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paul Kelly Maxillofacial PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gilbert, AZ
  • NPI 1316324031
  NPD (past) Authorized official
• Arizona Maxillofacial Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mesa, AZ
  • NPI 1932132651
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1447202148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 N GREENFIELD RD",
            "address_2": "SUITE #117",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345061",
            "telephone_number": "480-685-9696",
            "fax_number": "480-378-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 N GREENFIELD RD",
            "address_2": "SUITE 117",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852345061",
            "telephone_number": "480-685-9696",
            "fax_number": "480-378-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "PAUL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D6913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "D6913",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allysen Kelly, N.P.
• Colin K Kelly
• Justin William Kelly
• Kimberly Kelly
• Patricia Kelly
• Kaila Kelson
• Tara Ellan Kemnitz, LMT
• Carly Lin Kemp, FNP-BC
• Maria S Kenneally, APNP, BC
• Brian Kennedy, PA-C

• Oral and Maxillofacial Surgery (Dentist) in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.