| Johnathon Keller Dds Llc | |
|
3715 Kentucky Ave Indianapolis IN 46221-2757 | |
| (317) 946-4464 | |
| Not Available |
| Full Name | Johnathon Keller Dds Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3715 Kentucky Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Johnathon M Keller (DENTIST) |
| Authorized Official Contact | 3179464464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnathon Keller Dds Llc 3715 Kentucky Ave Indianapolis IN 46221-2757 Ph: (317) 946-4464 | Johnathon Keller Dds Llc 3715 Kentucky Ave Indianapolis IN 46221-2757 Ph: (317) 946-4464 |
| NPI Number | 1790300242 |
|---|---|
| Provider Enumeration Date | 06/10/2020 |
| Last Update Date | 06/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790300242 | NPI | - | NPPES |
| 201375420 | Medicaid | IN | |
| 13885169 | Other | IN | CAQH |
| 1578912341 | Other | IN | NPI TYPE 1 |
| 12012526A | Other | IN | IN DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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