Provider Demographics
NPI:1386702751
Name:KELLER, JAMES F (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:KELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:FREDERICK
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2508 E FOX FARM RD # 1-1A
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2559
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:307-635-1442
Practice Address - Street 1:2508 E FOX FARM RD # 1-1A
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2559
Practice Address - Country:US
Practice Address - Phone:307-635-3618
Practice Address - Fax:307-635-1442
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice