Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 20271 | TX |
NPI | 1023163565 |
---|---|
Provider Name | Dr. Todd Alan Keller |
First Address | New Braunfels, TX 78130-3178 |
Second Address | New Braunfels, TX 78130-3178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |