| NPI | 1356475636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS ALAN KELLER General Dentist 631-669-0027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 035664) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2013-04-18 |