Healthcare Provider Details

I. General information

NPI: 1053205385
Provider Name (Legal Business Name): DANIEL KELLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAPLE STREET
ISLAND POND VT
05846
US

IV. Provider business mailing address

3184 VT ROUTE 105
WEST CHARLESTON VT
05872-9705
US

V. Phone/Fax

Practice location:
  • Phone: 802-723-4300
  • Fax:
Mailing address:
  • Phone: 989-444-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0134358
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: