Provider Demographics
NPI:1104848209
Name:KELLER, LUCINDA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:S
Last Name:KELLER
Suffix:
Gender:F
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-0339
Mailing Address - Country:US
Mailing Address - Phone:410-535-4022
Mailing Address - Fax:410-535-0809
Practice Address - Street 1:1430 SOLOMONS ISLAND RD
Practice Address - Street 2:#3
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-0339
Practice Address - Country:US
Practice Address - Phone:410-535-4022
Practice Address - Fax:410-535-0809
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD93691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice