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General NPI Number Information
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NPI Number | 1184799819
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Entity Type | Individual
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Provider Name | MYRON KELLNER D.D.S.,P.A.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2324 W JOPPA RD SUITE 110
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City | LUTHERVILLE
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State | MD
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Zip | 21093-4615
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Country | US
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Telephone | 410-321-1100
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Fax | 410-321-8376
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Provider Business Mailing Address
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Address Line | 3301 BRIDLE RDG
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City | STEVENSON
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State | MD
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Zip | 21153-2032
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Country | US
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Telephone | 410-484-1551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4892
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License Number State | MD
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