# DR. KLINT R KELLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1942228176
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3610 | ID | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 04/21/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010143908 | BLUE SHIELD OF ID | ID |
| 01 | — | 01478887 | UNITED CONCORDIA INS | ID |
| 01 | — | 6H361 | BLUE CROSS INS | ID |
| 05 | — | 806628200 | — | ID |