Provider Demographics
NPI:1760520241
Name:KELTNER, GOODLOE MALONE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOODLOE
Middle Name:MALONE
Last Name:KELTNER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:5866 RIDGE BEND RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9477
Mailing Address - Country:US
Mailing Address - Phone:901-680-0364
Mailing Address - Fax:901-680-0368
Practice Address - Street 1:5866 RIDGE BEND RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9477
Practice Address - Country:US
Practice Address - Phone:901-680-0364
Practice Address - Fax:901-680-0368
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDS37661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice