Organization
PEDIATRIC DENTISTRY OF KELLER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB JOHNSON DDS (MEMBER)
(480) 207-9709
Entity
Organization
Contact information
Practice address
1627 KELLER PARKWAY, SUITE 100, KELLER, TX 76248
(480) 207-9709
Mailing address
2101 BRADLEY DR, KELLER, TX 76248-6868
(480) 207-9709
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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