Provider Demographics
NPI:1588064802
Name:KELLER, ZACHARY (DMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1516
Mailing Address - Country:US
Mailing Address - Phone:314-596-8655
Mailing Address - Fax:
Practice Address - Street 1:4521 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1516
Practice Address - Country:US
Practice Address - Phone:314-596-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist