KELLERMAN DENTAL GROUP, PC (NPI# 1538543582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538543582 |
| Entity Type | Organization |
| Organization Name | KELLERMAN DENTAL GROUP, PC |
| Other Organization Name | KELLERMAN COSMETIC AND FAMILY DENTISTRY |
| Practice Address |
16 Junction Dr W Ste 101 Glen Carbon IL 62034-2996 |
| Practice Telephone | 6182883535 |
| Practice Fax Number | 6182883434 |
| Mailing Telephone | 6182883535 |
| Mailing Fax Number | 6182883434 |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-18 |
| Authorized Official Name | DR. KEVIN J KELLERMAN (PRESIDENT) |
| Authorized Official Telephone | 6182883535 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
019025862 | IL | Suppliers |
| Other Name | Type Code |
|---|---|
| Kellerman Cosmetic and Family Dentistry | Doing Business As Name - Organization |
| Street Address |
16 JUNCTION DR W STE 101 |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034-2996 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215102579 | Kellerman Dental | Dentist | 16 Junction Dr W Ste 101, Glen Carbon, IL 62034-2996 | 2008-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 332BC3200X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Customized Equipment |
| Definition to come... |
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| 1760951818 | Always Great Smiles Dot Com PC | Durable Medical Equipment & Medical Supplies | 586 Duane St, Glen Ellyn, IL 60137-4639 | 2018-11-19 |
| 1285123349 | Sleep Better Illinois LLC | Durable Medical Equipment & Medical Supplies | 261 N Randall Rd Ste 103, Lake In The Hills, IL 60156-5999 | 2018-05-04 |
| 1588151302 | Rinella Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 27w130 Roosevelt Rd # 2e, Winfield, IL 60190-1611 | 2018-04-17 |
| 1205353695 | Nutoys Leisure Products, Inc. | Durable Medical Equipment & Medical Supplies | 915 W Hillgrove Ave, La Grange, IL 60525-5823 | 2017-08-25 |
| 1528509833 | International Medical Equipment Distributors LLC | Durable Medical Equipment & Medical Supplies | 8501 W Higgins Rd Ste 710, Chicago, IL 60631-2883 | 2017-03-20 |
| 1508303553 | Kasper Healthcare Enterprises, Inc | Durable Medical Equipment & Medical Supplies | 11535 183rd Pl, Orland Park, IL 60467-4905 | 2017-01-30 |
| Find all providers with the same taxonomy | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
Please comment or provide details below to improve the information on KELLERMAN DENTAL GROUP, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.