Individual
BRIAN PATRICK KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
W230S4497 MILKY WAY ROAD, WAUKESHA, WI 53189
(262) 312-8384
Mailing address
W230S4497 MILKY WAY ROAD, WAUKESHA, WI 53189
(262) 312-8384
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5197-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
397627370000
BLUE CROSS/BLUE SHIELD
WI
Enumeration date
11/07/2005
Last updated
02/21/2025
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