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Organization

KELLERMAN DENTAL GROUP, PC

Active
Other names
Kellerman Cosmetic and Family Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KEVIN J KELLERMAN DMD (PRESIDENT)
(618) 288-3535
Entity
Organization

Contact information

Practice address
16 JUNCTION DR W STE 101, GLEN CARBON, IL 62034-2996
(618) 288-3535
(618) 288-3434
Mailing address
16 JUNCTION DR W STE 101, GLEN CARBON, IL 62034-2996
(618) 288-3535
(618) 288-3434

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
019025862
IL

Other

Enumeration date
07/18/2015
Last updated
07/18/2015
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