Provider Demographics
NPI:1043471311
Name:KELLER PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:KELLER PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-431-6008
Mailing Address - Street 1:1858 KELLER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3757
Mailing Address - Country:US
Mailing Address - Phone:817-431-6008
Mailing Address - Fax:817-337-0098
Practice Address - Street 1:1858 KELLER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3757
Practice Address - Country:US
Practice Address - Phone:817-431-6008
Practice Address - Fax:817-337-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty