Organization
SOUTH CENTRAL ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E. KELLER D.D.S. ,M.S.D. (OWNER)
(812) 372-3636
Entity
Organization
Contact information
Practice address
3200 MIDDLE DR, COLUMBUS, IN 47203-4426
(812) 372-3636
(812) 378-3636
Mailing address
3200 MIDDLE DR, COLUMBUS, IN 47203-4426
(812) 372-3636
(812) 378-3636
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
12008103B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
405356
UNITED CONCORDIA ID
IN
Enumeration date
06/05/2007
Last updated
06/30/2015
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