John B Keller, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019022829 Issued in IL

Practice address

1701 Clearwater Ave
Suite B
Bloomington, IL 61704-6433

Phone

(309) 662-7949

Fax

(309) 664-6177

NPI assigned

Oct 7, 2011

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317945600000",
    "number": "1912281965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CLEARWATER AVE",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046433",
            "telephone_number": "309-662-7949",
            "fax_number": "309-664-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLEARWATER AVE",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046433",
            "telephone_number": "309-662-7949",
            "fax_number": "309-664-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-07",
        "last_updated": "2011-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019022829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Keck, MS, LAT, ATC
• Keelan Dennis MFT
• Allison Courtney Keeran, CSFA
• Ashley Kelch
• Brett L. Keller, D.O.
• Kimberly A. Keller, OT
• Bonny Kelley
• Adam Kelly
• Brooke Kennard, APN
• Mychele Kenney, LCPC

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; 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.