Healthcare Provider Details

I. General information

NPI: 1215831433
Provider Name (Legal Business Name): JAY KELTNER DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E LAGOON ST
ROOSEVELT UT
84066-3017
US

IV. Provider business mailing address

375 E LAGOON ST
ROOSEVELT UT
84066-3017
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-2293
  • Fax: 435-722-3379
Mailing address:
  • Phone: 435-722-2293
  • Fax: 435-722-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CORWIN JAY KELTNER
Title or Position: DDS/ OWNER
Credential:
Phone: 435-722-2293