Organization
THOMAS C. KELLEY DDS MSD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS C KELLEY DDS, MSD (PERIODONTIST)
(262) 787-9075
Entity
Organization
Contact information
Practice address
17280 W NORTH AVE STE 203, BROOKFIELD, WI 53045-4366
(262) 787-9075
(262) 787-9076
Mailing address
17280 W NORTH AVE STE 203, BROOKFIELD, WI 53045-4366
(262) 787-9075
(262) 787-9076
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
5257015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33778000
—
WI
Enumeration date
07/29/2010
Last updated
07/29/2010
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