Healthcare Provider Details

I. General information

NPI: 1922085034
Provider Name (Legal Business Name): JULIETTE KELLER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536
US

IV. Provider business mailing address

800 ROSE ST D104
LEXINGTON KY
40536-2335
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6261
  • Fax:
Mailing address:
  • Phone: 859-323-3368
  • Fax: 859-257-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5985
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: