MEDICARE: DR. BARRY G KELLER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS022191L	PA

General Provider Information

NPI Number	:	1154439370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY G KELLER DMD

Provider Business Mailing Address
First Line	:	2465 NEW HOLLAND PIKE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601
Country	:	US
Telephone Number	:	717-656-8004
Fax Number	:	717-656-7782

Provider Business Practice Location Address
First Line	:	2465 NEW HOLLAND PIKE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601
Country	:	US
Telephone Number	:	717-656-8004
Fax Number	:	717-656-7782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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