Active NPI
David Arlington Keller Sr., DDS
- Dentist
- Vancouver, WA
National Provider Identifier
1386647949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00011209
- Practice address
- 215 NW 78TH St
Vancouver, WA 98665-7972 - Phone
- (360) 693-2577
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DE00011209 | WA | Primary |
Addresses
Primary practice location
215 NW 78TH St
Vancouver, WA 98665-7972
Mailing address
215 NW 78TH St
Vancouver, WA 98665-7972
Phone (360) 693-2577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160330000358 | WA | Order and Referring Only - Oral Surgery | 8527365980 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00011209 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1386647949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 NW 78TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986657972",
"telephone_number": "360-693-2577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 NW 78TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986657972",
"telephone_number": "360-693-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "DAVID",
"middle_name": "ARLINGTON",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00011209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.