| Kellerman Dental | |
|
16 Junction Dr W Ste 101 Glen Carbon IL 62034-2996 | |
| (618) 288-3535 | |
| Not Available |
| Full Name | Kellerman Dental |
|---|---|
| Speciality | Dentist |
| Location | 16 Junction Dr W Ste 101, Glen Carbon, Illinois |
| Authorized Official Name and Position | Kevin J Kellerman (DOCTOR) |
| Authorized Official Contact | 6182883535 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kellerman Dental 16 Junction Dr W Ste 101 Glen Carbon IL 62034-2996 Ph: (618) 288-3535 | Kellerman Dental 16 Junction Dr W Ste 101 Glen Carbon IL 62034-2996 Ph: (618) 288-3535 |
| NPI Number | 1215102579 |
|---|---|
| Provider Enumeration Date | 04/28/2008 |
| Last Update Date | 04/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215102579 | NPI | - | NPPES |
| 108441 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1004560 (Illinois) | Primary |
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