Provider Demographics
NPI:1053205385
Name:KELLER, DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 VT ROUTE 105
Mailing Address - Street 2:
Mailing Address - City:WEST CHARLESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05872-9705
Mailing Address - Country:US
Mailing Address - Phone:989-444-9405
Mailing Address - Fax:
Practice Address - Street 1:82 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ISLAND POND
Practice Address - State:VT
Practice Address - Zip Code:05846
Practice Address - Country:US
Practice Address - Phone:802-723-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0134358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist