Matthew Keller, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN014428 Issued in GA

Practice address

4405 N Stadium Dr Ste B
Columbus, GA 31909-1884

Phone

(706) 225-0444

Fax

(706) 940-0008

NPI assigned

Mar 29, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbus Children'S Dentistry, PC

  • Pediatric Dentistry
  • Columbus, GA
  • NPI 1063828499
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1134495591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 N STADIUM DR STE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091884",
            "telephone_number": "706-225-0444",
            "fax_number": "706-940-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 N STADIUM DR STE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091884",
            "telephone_number": "706-225-0444",
            "fax_number": "706-940-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elliott Kees
• Amber Nichole Keeton, PHARMD
• Ericka L Keith, ST/MFT
• Stephanie Ryan Keith, LAPC
• Laquietta Christina Keller
• Jason Kelley
• Olivia Henderson Kelley, NP
• Sandra K Kelley, CRNP
• Kenarin Kellogg
• Kelly H Nilsson, OD, PA

• Pediatric Dentistry in Columbus, GA
• Providers in Columbus, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.