Provider Demographics
NPI:1174906887
Name:R. L. KELLER DDS & DANIEL F. BURK DDS
Entity type:Organization
Organization Name:R. L. KELLER DDS & DANIEL F. BURK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPPINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-757-5081
Mailing Address - Street 1:3107 LONE TREE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4980
Mailing Address - Country:US
Mailing Address - Phone:925-757-5081
Mailing Address - Fax:925-757-4979
Practice Address - Street 1:3107 LONE TREE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4980
Practice Address - Country:US
Practice Address - Phone:925-757-5081
Practice Address - Fax:925-757-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290211223G0001X
CA05167881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty