Healthcare Provider Details

I. General information

NPI: 1922066562
Provider Name (Legal Business Name): RICHARD H KELLER DDS,MPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 REDWING RD SUITE 300
FORT COLLINS CO
80526-6321
US

IV. Provider business mailing address

2627 REDWING RD SUITE 300
FORT COLLINS CO
80526-6321
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-0250
  • Fax: 970-484-1522
Mailing address:
  • Phone: 970-484-0250
  • Fax: 970-484-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0004119
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberCO9765
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: