Provider Demographics
NPI:1477668424
Name:KELLER, PETER ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALLEN
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 1:5410 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2203
Mailing Address - Country:US
Mailing Address - Phone:954-262-7322
Mailing Address - Fax:954-262-1782
Practice Address - Street 1:3200 N UNIVERSITY DRIVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-262-7322
Practice Address - Fax:954-262-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist