MEDICARE: THOMAS FRANKLIN KELLER DDS

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	1223G0001X	General Practice Dentistry	30017100	OH

General Provider Information

NPI Number	:	1154844322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS FRANKLIN KELLER DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 507
Second Line	:
City	:	OWENSVILLE
State	:	OH
Zip	:	45160
Country	:	US
Telephone Number	:	513-375-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-3916
Country	:	US
Telephone Number	:	513-401-7536
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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