Provider Demographics
NPI:1003919416
Name:KELLER, DANIEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:KELLER
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 1:2145 EAST TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-323-2517
Mailing Address - Fax:760-323-1627
Practice Address - Street 1:2145 EAST TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-323-2517
Practice Address - Fax:760-323-1627
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist