Provider Demographics
NPI:1013024116
Name:OUSBORNE AND KELLER, D.D.S., P.A.
Entity Type:Organization
Organization Name:OUSBORNE AND KELLER, D.D.S., P.A.
Other - Org Name:OUSBORNE & KELLER, D.D.S., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:OUSBORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-828-1177
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-828-1177
Mailing Address - Fax:410-828-1252
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:104
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-828-1177
Practice Address - Fax:410-828-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3988122300000X
MD5771122300000X
MD11305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty