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General NPI Number Information
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NPI Number | 1366423527
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Entity Type | Individual
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Provider Name | BRIAN PATRICK KELLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | W230S4497 MILKY WAY ROAD
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City | WAUKESHA
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State | WI
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Zip | 53189
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Country | US
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Telephone | 262-312-8384
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Fax |
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Provider Business Mailing Address
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Address Line | W230S4497 MILKY WAY ROAD
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City | WAUKESHA
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State | WI
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Zip | 53189
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Country | US
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Telephone | 262-312-8384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5197-015
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License Number State | WI
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