Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 44713 | CA |
NPI | 1063505329 |
---|---|
Provider Name | Dr. Tom D Keller |
First Address | Encinitas, CA 92024-2931 |
Second Address | Encinitas, CA 92024-2931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 08/07/2007 |