Provider Demographics
NPI:1639170467
Name:KELLER, REBECCA BARTOLI (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BARTOLI
Last Name:KELLER
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Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1301 SUNNYVALE SARATOGA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-739-4224
Mailing Address - Fax:408-739-7331
Practice Address - Street 1:1301 SUNNYVALE SARATOGA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-739-4224
Practice Address - Fax:408-739-7331
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA456441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics