Organization
COLUMBUS CHILDREN'S DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LEE KELLER DMD (DENTIST/OWNER)
(706) 225-0444
Entity
Organization
Contact information
Practice address
4405 N STADIUM DR, SUITE B, COLUMBUS, GA 31909-1878
(706) 225-0444
(706) 940-0008
Mailing address
4405 N STADIUM DR, SUITE B, COLUMBUS, GA 31909-1878
(706) 225-0444
(706) 940-0008
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN014428
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003145601A
—
GA
Enumeration date
07/07/2014
Last updated
07/07/2014
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