Provider Demographics
NPI:1659857522
Name:KELLER, CHANTEL RUEB (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:RUEB
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 1:2915 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4985
Mailing Address - Country:US
Mailing Address - Phone:254-214-9030
Mailing Address - Fax:
Practice Address - Street 1:803 S 37TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5279
Practice Address - Country:US
Practice Address - Phone:254-214-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74951223G0001X
TX368491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice