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General NPI Number Information
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NPI Number | 1023178985
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Entity Type | Organization
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Legal Business Name | KARL A KELLER DDS PC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 312 W DIVISION ST
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City | MANTENO
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State | IL
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Zip | 60950
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Country | US
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Telephone | 815-468-6800
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Fax | 815-468-7780
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Provider Business Mailing Address
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Address Line | 312 W DIVISION ST
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City | MANTENO
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State | IL
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Zip | 60950
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Country | US
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Telephone | 815-468-6800
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Fax | 815-468-7780
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARL A KELLER
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Credential | DDS
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Telephone | 815-468-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019017215
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License Number State | IL
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