Provider Demographics
NPI:1720546401
Name:KELLER DENTISTRY LLC
Entity Type:Organization
Organization Name:KELLER DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-752-9828
Mailing Address - Street 1:1431 KELLER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3860
Mailing Address - Country:US
Mailing Address - Phone:817-752-9828
Mailing Address - Fax:817-752-9829
Practice Address - Street 1:1431 KELLER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3860
Practice Address - Country:US
Practice Address - Phone:817-752-9828
Practice Address - Fax:817-752-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental