Organization
KELLERMAN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J KELLERMAN (DOCTOR)
(618) 288-3535
Entity
Organization
Contact information
Practice address
16 JUNCTION DR W STE 101, GLEN CARBON, IL 62034-2996
(618) 288-3535
Mailing address
16 JUNCTION DR W STE 101, GLEN CARBON, IL 62034-2996
(618) 288-3535
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1004560
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108441
—
IL
Enumeration date
04/28/2008
Last updated
04/28/2008
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