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Deactivated NPI 1003883083 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth J. Kelly , DDS

Dentist - General Practice • Braintree, MA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kenneth Kelly has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 08, 2006
NPI Deactivation Date April 22, 2019
Total Practice Duration ~13 Years of Practice (2006 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Kelly, DDS was a registered Dentist - General Practice practicing in Braintree, MA. Throughout an active medical career spanning 13 years, Dr. Kelly provided care at the practice location at 111 GROSSMAN DR until profile deactivation on 2019-04-22.

Practice Location & Contact Primary Location

Practice Address

111 Grossman Dr

Braintree, MA 021844997

Telephone 7818492255
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Braintree, MA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.9 Yrs
Regional Practice Density
31 Specialists

Practicing in Braintree, MA (3722 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MA 15939

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Mytrei Chaturvedula , DMD

Dentist - General Practice

NPI 1174592786

Doctor of Dental Medicine

Dr. Raymond Widican , DDS

Dentist - Pediatric Dentistry

NPI 1629047139

Doctor of Dental Surgery

NPI 1790896355

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 22, 2019

Record deactivated on April 22, 2019

NPI Profile Active April 07, 2009

NPI status registered as active in NPPES database

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Updated Practice Location April 07, 2009

Registered at 111 GROSSMAN DR, BRAINTREE, MA 021844997 (Tel: 7818492255)

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Updated Business Mailing Address April 07, 2009

Registered at 147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 021094806 (Tel: 6175598051)

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Provider Name / Credentials Updated April 07, 2009

Recorded as KENNETH KELLY, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 07, 2009

Dentist (License #15939 in MA)

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Initial NPI Registration & Enumeration March 08, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003883083
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 08, 2006
Last Update: April 07, 2009
Deactivation Date: April 22, 2019

Mailing Address

147 Milk St, Provider Enrollment 9th Floor

Boston, MA 021094806

Phone: 6175598051

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.