Individual
DR. KLINT R KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
203 7TH AVE S, NAMPA, ID 83651-3846
(208) 466-8400
(208) 466-8436
Mailing address
203 7TH AVE S, NAMPA, ID 83651-3846
(208) 466-8400
(208) 466-8436
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3610
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010143908
BLUE SHIELD OF ID
ID
01
—
01478887
UNITED CONCORDIA INS
ID
01
—
6H361
BLUE CROSS INS
ID
05
—
806628200
—
ID
Enumeration date
07/17/2006
Last updated
04/21/2015
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