Provider Demographics
NPI:1841704947
Name:KELLER, ROBIN LAINE (RDH)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LAINE
Last Name:KELLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:LAINE
Other - Last Name:HOSKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1631 WETZEL AVE BLDG 815
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1631 WETZEL AVE BLDG 815
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4095
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904129124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist