Provider Demographics
NPI:1548636558
Name:KELLER, ANDREW JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:KELLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 112TH AVE NE STE P104
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8589
Mailing Address - Country:US
Mailing Address - Phone:425-409-9999
Mailing Address - Fax:
Practice Address - Street 1:909 112TH AVE NE STE P104
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8589
Practice Address - Country:US
Practice Address - Phone:425-409-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60555911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist