Provider Demographics
NPI:1447620133
Name:KELLER TOWN DENTAL
Entity type:Organization
Organization Name:KELLER TOWN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-680-9985
Mailing Address - Street 1:121 RUFE SNOW DR STE 111
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2111
Mailing Address - Country:US
Mailing Address - Phone:817-337-7941
Mailing Address - Fax:
Practice Address - Street 1:121 RUFE SNOW DR STE 111
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2111
Practice Address - Country:US
Practice Address - Phone:817-337-7941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty