Provider Demographics
NPI:1558410381
Name:KELLAR, ROBERT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KELLAR
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 1:103 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1903
Mailing Address - Country:US
Mailing Address - Phone:937-845-0038
Mailing Address - Fax:937-845-8724
Practice Address - Street 1:103 S CHURCH STREET
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1903
Practice Address - Country:US
Practice Address - Phone:937-845-0038
Practice Address - Fax:937-845-8724
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300156531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice