Madeline Kelley, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D11401 Issued in OR

Practice address

1245 SE 3Rd St
Bend, OR 97702-2161

Phone

(541) 318-5688

NPI assigned

Jul 4, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1861988685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 SE 3RD ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022161",
            "telephone_number": "541-318-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 SE 3RD ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977022161",
            "telephone_number": "541-318-5688"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 SW Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972015042",
            "country_code": "US",
            "telephone_number": "502-494-8921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MADELINE",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OR",
            "license": "D11401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Emily Keller, LCSW
• Abigail Kelley, MCOUN
• Bailey M Kelley, DPT
• Kara A Kelley, RN
• Kimberly Michelle Kelley, LPC
• Mary Allegra Kelley, DO
• Sarah Elizabeth Kelley
• Suzanne Nicole Kelley
• Thomas Christopher Kelley, DO
• Lezlie Neusteter Kellison, LCSW

• Orthodontics and Dentofacial Orthopedics Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; 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.