=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245134220
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYLE P. KELLER, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 465 E BATH RD
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-929-5496
-----------------------------------------------------
Fax | 330-929-6292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 465 E BATH RD
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-929-5496
-----------------------------------------------------
Fax | 330-929-6292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. KYLE P KELLER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 330-929-5496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------