Provider Demographics
NPI:1295087443
Name:KELLER GROUP, INC.
Entity type:Organization
Organization Name:KELLER GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO OF GDC HOLDINGS
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:561-537-8305
Mailing Address - Street 1:160 LARKIN WILLIAMS IND CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2409
Mailing Address - Country:US
Mailing Address - Phone:636-717-1755
Mailing Address - Fax:636-600-4396
Practice Address - Street 1:160 LARKIN WILLIAMS IND CT
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2409
Practice Address - Country:US
Practice Address - Phone:636-717-1755
Practice Address - Fax:636-600-4396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GDC HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory