=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073995940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH ELIZABETH KELLER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2015
-----------------------------------------------------
Last Update Date | 05/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5850 WECKERLY RD
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43571-9510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-877-5404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5850 WECKERLY RD
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43571-9510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-877-5404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30027182
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------