Individual
DR. CORWIN JAY KELTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, PPA
Contact information
Practice address
5974 FASHION POINT DR STE 210, OGDEN, UT 84403-4842
(801) 475-6121
Mailing address
33 CANTERBURY LN, LOGAN, UT 84321-6714
(435) 773-2529
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
323334-9922
UT
1223G0001X
General Practice Dentistry
60068
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100392360B
—
KS
01
—
116645
BLUE CROSS BLUE SHIELD ID
KS
Enumeration date
10/26/2005
Last updated
12/11/2022
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