MEDICARE: KELLER PROFESSIONAL GROUP, DMD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	122300000X	Dentist

General Provider Information

NPI Number	:	1306935986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLER PROFESSIONAL GROUP, DMD, PC

Provider Business Mailing Address
First Line	:	3929 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1437
Country	:	US
Telephone Number	:	314-638-4190
Fax Number	:	314-638-3900

Provider Business Practice Location Address
First Line	:	3929 BAYLESS AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1437
Country	:	US
Telephone Number	:	314-638-4190
Fax Number	:	314-638-3900

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUANE CLAY KELLER
Credential	:	D.M.D.
Telephone Number	:	314-638-4190

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/11/2025

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