Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2388 | MT |
NPI | 1063662294 |
---|---|
Provider Name | Dr. Brady S Keller |
First Address | Billings, MT 59102-7654 |
Second Address | Billings, MT 59102-0700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 02/01/2020 |