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Individual

DR. KETTI R BOLLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S, M.S

Contact information

Practice address
123 N MAIN ST STE 101, CROWN POINT, IN 46307-4077
(219) 663-2000
(219) 322-7667
Mailing address
123 N MAIN ST STE 101, CROWN POINT, IN 46307-4077
(219) 663-2000
(219) 322-7667

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12014618A
IN

Other

Enumeration date
09/25/2012
Last updated
04/17/2025
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