Provider Demographics
NPI:1508984626
Name:KELLNER, ALAN SCOTT (DMD, DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:KELLNER
Suffix:
Gender:M
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 FOREST HILL BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5662
Mailing Address - Country:US
Mailing Address - Phone:561-965-8888
Mailing Address - Fax:561-965-8897
Practice Address - Street 1:3650 FOREST HILL BLVD
Practice Address - Street 2:STE 3
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5662
Practice Address - Country:US
Practice Address - Phone:561-965-8888
Practice Address - Fax:561-965-8897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN140541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice