Active NPI
Roger Dale Keller, DDS
- Dentist
- Bristol, TN
National Provider Identifier
1962661223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3840
- Practice address
- 1039 Highway 126
Bristol, TN 37620-3223 - Phone
- (423) 764-5500
- Fax
- (423) 764-5503
- NPI assigned
- Jun 3, 2008
- Last updated
- Jun 3, 2008
- 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 | 3840 | TN | Primary |
Addresses
Primary practice location
1039 Highway 126
Bristol, TN 37620-3223
Mailing address
1039 Hwy 126
Bristol, TN 37620
Phone (423) 764-5500
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 |
|---|---|---|---|
| 3840 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212451200000",
"number": "1962661223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1039 HWY 126",
"city": "BRISTOL",
"state": "TN",
"postal_code": "37620",
"telephone_number": "423-764-5500",
"fax_number": "423-764-5503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1039 HIGHWAY 126",
"city": "BRISTOL",
"state": "TN",
"postal_code": "376203223",
"telephone_number": "423-764-5500",
"fax_number": "423-764-5503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "ROGER",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-03",
"last_updated": "2008-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "3840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.