Shannon Renae Keiser, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30.24823 Issued in OH

Practice address

375 Independence Dr Suite 110, Ekko Dental Studio
Napoleon, OH 43545-8660

Phone

(419) 592-0034

Fax

(419) 592-5200

NPI assigned

Jun 10, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Premier Care Dentistry of Ohio LLC

  • Dentist
  • Toledo, OH
  • NPI 1588545933
  NPD (past)

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1134578040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 INDEPENDENCE DR SUITE 110",
            "city": "NAPOLEON",
            "state": "OH",
            "postal_code": "435458660",
            "telephone_number": "419-592-5200",
            "fax_number": "419-592-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 INDEPENDENCE DR SUITE 110, EKKO DENTAL STUDIO",
            "city": "NAPOLEON",
            "state": "OH",
            "postal_code": "435458660",
            "telephone_number": "419-592-0034",
            "fax_number": "419-592-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEISER",
        "first_name": "SHANNON",
        "middle_name": "RENAE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-10",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.24823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE # FOR OHIO",
            "identifier": "30.24823",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Jones, MS, CCC-SLP
• Ellen E Justus, DMD
• Kevin Kaplan, LSW
• Richard Kauzlick, LSW
• Mohamed Kazbour, DDS
• Anthony John Kestranek, D.M.D
• James Jude Kettinger, MD
• Nathan Laiming Khoo, DDS
• Joyce Klear, LSW
• Mindy J Kleiman

• Dentist in Napoleon, OH
• Providers in Napoleon, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.