Provider Demographics
NPI:1144222472
Name:TODD A KELLER, DDS, PA
Entity type:Organization
Organization Name:TODD A KELLER, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:830-629-5055
Mailing Address - Street 1:1902 COMMON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3156
Mailing Address - Country:US
Mailing Address - Phone:830-629-5055
Mailing Address - Fax:830-629-2528
Practice Address - Street 1:1902 COMMON ST
Practice Address - Street 2:STE 100
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3156
Practice Address - Country:US
Practice Address - Phone:830-629-5055
Practice Address - Fax:830-629-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20271261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental