Active NPI
Michael David Keller, D.M.D.
- Dentist
- Rehoboth Beach, DE
National Provider Identifier
1972896322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- G1-0001318
- Practice address
- 19643 Blue Bird LN
Rehoboth Beach, DE 19971-6129 - Phone
- (302) 226-7960
- NPI assigned
- May 18, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | G3-0000382 | DE | |
| Dentist | 122300000X | G1-0001318 | DE | Primary |
Addresses
Primary practice location
19643 Blue Bird LN
Rehoboth Beach, DE 19971-6129
Mailing address
15254 Robinson Dr
Milton, DE 19968-3784
Phone (302) 542-6337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
- 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 |
|---|---|---|---|---|
| I20150622001828 | DE | Order and Referring Only - Dentist | 1759692429 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G3-0000382 | DE | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371427200000",
"number": "1972896322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15254 ROBINSON DR",
"city": "MILTON",
"state": "DE",
"postal_code": "199683784",
"telephone_number": "302-542-6337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19643 BLUE BIRD LN",
"city": "REHOBOTH BEACH",
"state": "DE",
"postal_code": "199716129",
"telephone_number": "302-226-7960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "MICHAEL",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-18",
"last_updated": "2013-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "DE",
"license": "G3-0000382",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "DE",
"license": "G1-0001318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rehoboth Beach, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; 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.