| Thomas C. Kelley DDS Msd LLC | |
|
17280 W North Ave Ste 203 Brookfield WI 53045-4366 | |
| (262) 787-9075 | |
| (262) 787-9076 |
| Full Name | Thomas C. Kelley DDS Msd LLC |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 17280 W North Ave Ste 203, Brookfield, Wisconsin |
| Authorized Official Name and Position | Thomas C Kelley (PERIODONTIST) |
| Authorized Official Contact | 2627879075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas C. Kelley DDS Msd LLC 17280 W North Ave Ste 203 Brookfield WI 53045-4366 Ph: (262) 787-9075 | Thomas C. Kelley DDS Msd LLC 17280 W North Ave Ste 203 Brookfield WI 53045-4366 Ph: (262) 787-9075 |
| NPI Number | 1780998997 |
|---|---|
| Provider Enumeration Date | 07/29/2010 |
| Last Update Date | 07/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780998997 | NPI | - | NPPES |
| 33778000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 5257015 (Wisconsin) | Primary |
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