Provider Demographics
NPI:1184799819
Name:KELLNER, MYRON (DDS,PA)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:KELLNER
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BRIDLE RDG
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-2032
Mailing Address - Country:US
Mailing Address - Phone:410-484-1551
Mailing Address - Fax:
Practice Address - Street 1:2324 W JOPPA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4615
Practice Address - Country:US
Practice Address - Phone:410-321-1100
Practice Address - Fax:410-321-8376
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist