Provider Demographics
NPI:1831310622
Name:KELLER, SHAWN MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARTIN
Last Name:KELLER
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 1:7530 164TH AVE NE
Mailing Address - Street 2:SUITE #A230
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7812
Mailing Address - Country:US
Mailing Address - Phone:425-558-1515
Mailing Address - Fax:425-882-1040
Practice Address - Street 1:7530 164TH AVE NE
Practice Address - Street 2:SUITE #A230
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7812
Practice Address - Country:US
Practice Address - Phone:425-558-1515
Practice Address - Fax:425-882-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA901001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice