Provider Demographics
NPI:1669688750
Name:VANESSA N. KELLER, D.M.D. AND TRISHA M. YOUNG, D.M.D., PC
Entity Type:Organization
Organization Name:VANESSA N. KELLER, D.M.D. AND TRISHA M. YOUNG, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-725-4343
Mailing Address - Street 1:165 N MERAMEC AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3772
Mailing Address - Country:US
Mailing Address - Phone:314-725-4343
Mailing Address - Fax:314-725-3950
Practice Address - Street 1:165 N MERAMEC AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3772
Practice Address - Country:US
Practice Address - Phone:314-725-4343
Practice Address - Fax:314-725-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11994261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental