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General NPI Number Information
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NPI Number | 1316696172
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Entity Type | Individual
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Provider Name | BENJAMIN KELLER
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Gender | Male
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Dates
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Enumeration Date | 03/21/2022
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 10225 OCEAN HWY UNIT 203
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-6507
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Country | US
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Telephone | 843-314-0866
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Fax |
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Provider Business Mailing Address
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Address Line | 10225 OCEAN HWY UNIT 203
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-6507
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Country | US
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Telephone | 540-903-1731
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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 | DGD.10184
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License Number State | SC
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