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General NPI Number Information
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NPI Number | 1659857522
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Entity Type | Individual
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Provider Name | CHANTEL RUEB KELLER DDS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 803 S 37TH ST
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City | TEMPLE
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State | TX
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Zip | 76504-5279
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Country | US
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Telephone | 254-214-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 CHANNEL DR
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City | LINCOLN
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State | NE
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Zip | 68516-4985
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Country | US
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Telephone | 254-214-9030
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7495
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36849
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License Number State | TX
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