Healthcare Provider Details

I. General information

NPI: 1154439370
Provider Name (Legal Business Name): BARRY G KELLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 NEW HOLLAND PIKE
LANCASTER PA
17601
US

IV. Provider business mailing address

2465 NEW HOLLAND PIKE
LANCASTER PA
17601
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-8004
  • Fax: 717-656-7782
Mailing address:
  • Phone: 717-656-8004
  • Fax: 717-656-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS022191L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: