Healthcare Provider Details

I. General information

NPI: 1306935986
Provider Name (Legal Business Name): KELLER PROFESSIONAL GROUP, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 BAYLESS AVE
SAINT LOUIS MO
63125-1437
US

IV. Provider business mailing address

3929 BAYLESS AVE
SAINT LOUIS MO
63125-1437
US

V. Phone/Fax

Practice location:
  • Phone: 314-638-4190
  • Fax: 314-638-3900
Mailing address:
  • Phone: 314-638-4190
  • Fax: 314-638-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DUANE CLAY KELLER
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 314-638-4190