Klint R Keller, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3610 Issued in ID

Practice address

203 7TH Ave S
Nampa, ID 83651-3846

Phone

(208) 466-8400

Fax

(208) 466-8436

NPI assigned

Jul 17, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Dental Partners, PLLC

  • General Practice Dentistry
  • Nampa, ID
  • NPI 1962568782
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1942228176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 7TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513846",
            "telephone_number": "208-466-8400",
            "fax_number": "208-466-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 7TH AVE S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513846",
            "telephone_number": "208-466-8400",
            "fax_number": "208-466-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "KLINT",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS",
            "identifier": "01478887",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806628200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ID",
            "identifier": "000010143908",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INS",
            "identifier": "6H361",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kbe Behavioral Health & Forensic Services, LLC
• Tricia L Keefe, DO
• Jesse David Keeler, MD
• Kelsie Beth Keller, RBT
• Kim Benson Keller, DDS
• Tristen Isabella Keller, DPT
• Kelly B. Mansfield DDS PC
• Kelly E. Carlen, DDS PLLC
• Jessica Flores Kelly
• Makena Loryn Kelly, PA-C

• General Practice Dentistry in Nampa, ID
• Providers in Nampa, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.

Verify at the official NPI Registry.