Provider Demographics
NPI:1447488051
Name:KELLY, BRANDON JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JOHN
Last Name:KELLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 2ND ST SW
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2986
Mailing Address - Country:US
Mailing Address - Phone:507-281-3926
Mailing Address - Fax:
Practice Address - Street 1:723 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2986
Practice Address - Country:US
Practice Address - Phone:507-281-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice