Thomas C. Kelley DDS MSD LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

5257015 Issued in WI

Legal business name

THOMAS C. KELLEY DDS MSD LLC

Practice address

17280 W North Ave Ste 203
Brookfield, WI 53045-4366

Phone

(262) 787-9075

Fax

(262) 787-9076

NPI assigned

Jul 29, 2010

Last updated

Jul 29, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas C Kelley, DDS, MSDNPI 1770572828

Title

Periodontist

Phone

(262) 787-9075

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Christopher Kelley, DDS, MSD

  • Periodontics
  • Brookfield, WI
  • NPI 1770572828
  Authorized official Same address or phone

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1780998997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17280 W NORTH AVE STE 203",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454366",
            "telephone_number": "262-787-9075",
            "fax_number": "262-787-9076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17280 W NORTH AVE STE 203",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454366",
            "telephone_number": "262-787-9075",
            "fax_number": "262-787-9076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS C. KELLEY DDS MSD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "262-787-9075",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "5257015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33778000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Theis, OTR
• Alexandra G Theodosis, DNP, APNP, FNP-C
• Derek M Thiel, DC
• Christen Joanne Thieman, PT, DPT, OCS
• Kirsten Thiemke, PHD
• Thomas J. Melin, M.D., S.C.
• Ellen Alexandra Thomas, PC-IT
• Jacob Dylan Thomas
• John E Thomas, MD
• Kyla M L Thompson

• Periodontics in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Periodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; 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.