Madison Dawn Keller, DMD, MS

Individual provider Active NPI General Practice Dentistry · Willis, TX

NPI 1093445819 · NPPES record last updated Jun 14, 2022

Key facts

NPI
1093445819
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
38486 (TX)
Practice address
12360 Interstate 45 North
Willis, TX 77378
Phone
(281) 853-8283
NPI assigned
Jun 14, 2022
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
38486TXMDCounseling Psychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 38486 TX Yes

Addresses

Primary practice location

12360 Interstate 45 North
Willis, TX 77378

Mailing address

9900 Westpark Dr Ste 365
Houston, TX 77063-5377
Phone (281) 853-8283

Electronic endpoints

TypeEndpointUseAffiliation
Other URL Mkeller@cdp.dental

Other providers in Willis, TX

All providers in Willis, TX · General Practice Dentistry in Texas

Sources for this page

Verify at the official NPI Registry.