Individual
DR. KEVIN JOHN KELLERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
16 JUNCTION DR W, SUITE 101, GLEN CARBON, IL 62034-2996
(618) 228-3100
(618) 288-3434
Mailing address
16 JUNCTION DR W, SUITE 101, GLEN CARBON, IL 62034-2996
(618) 228-3100
(618) 288-3434
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-025862
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108441
—
IL
Enumeration date
08/01/2006
Last updated
05/13/2021
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