Provider Demographics
NPI:1972878197
Name:DONALD C. KELLNER DDS-AURORA PC
Entity Type:Organization
Organization Name:DONALD C. KELLNER DDS-AURORA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-859-3151
Mailing Address - Street 1:143 SOUTH LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505
Mailing Address - Country:US
Mailing Address - Phone:630-859-3151
Mailing Address - Fax:630-859-0105
Practice Address - Street 1:143 SOUTH LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505
Practice Address - Country:US
Practice Address - Phone:630-859-3151
Practice Address - Fax:630-851-0105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD C. KELLNER DDS-AURORA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017632122300000X
IL019028094122300000X
IL019024905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019017632Medicaid