Provider Demographics
NPI:1134204704
Name:KELLER, CYNTHIA J (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:ICHIRIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:45-950 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3205
Mailing Address - Country:US
Mailing Address - Phone:808-247-4291
Mailing Address - Fax:
Practice Address - Street 1:45-950 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3205
Practice Address - Country:US
Practice Address - Phone:808-247-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice