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General NPI Number Information
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NPI Number | 1700179710
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Entity Type | Individual
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Provider Name | KEITH CYRUS KELLER D.M.D
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Gender | Male
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 4010 82ND ST
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City | ELMHURST
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State | NY
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Zip | 11373-1305
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Country | US
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Telephone | 718-426-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 549 E 234TH ST APT 4C
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City | BRONX
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State | NY
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Zip | 10470-2454
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Country | US
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Telephone | 801-319-0407
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 055988
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License Number State | NY
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