Provider Demographics
NPI:1417058405
Name:KELLNER, DONALD CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CRAIG
Last Name:KELLNER
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 1:333 N WOOD DALE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191
Mailing Address - Country:US
Mailing Address - Phone:630-860-9100
Mailing Address - Fax:630-782-0662
Practice Address - Street 1:333 N WOOD DALE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191
Practice Address - Country:US
Practice Address - Phone:630-860-9100
Practice Address - Fax:630-782-0662
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice