Active NPI
Paul Elliott Keller, DDS
- General Practice Dentistry
- Goshen, IN
National Provider Identifier
1356516348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12007622A
- Practice address
- 1934 W Lincoln Ave
Goshen, IN 46526-5907 - Phone
- (574) 533-0722
- Fax
- (574) 534-2333
- NPI assigned
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12007622A | IN | Primary |
Addresses
Primary practice location
1934 W Lincoln Ave
Goshen, IN 46526-5907
Mailing address
1934 W Lincoln Ave
Goshen, IN 46526-5907
Phone (574) 533-0722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007622A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1356516348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1934 W LINCOLN AVE",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265907",
"telephone_number": "574-533-0722",
"fax_number": "574-534-2333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1934 W LINCOLN AVE",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265907",
"telephone_number": "574-533-0722",
"fax_number": "574-534-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "PAUL",
"middle_name": "ELLIOTT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12007622A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.