DR. JOHNATHAN MICHAEL KELLER (NPI# 1578912341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578912341 |
| Entity Type | Individual |
| Full Name | DR. JOHNATHAN MICHAEL KELLER |
| Credential | DDS |
| Practice Address |
1130 W Michigan St Fh204 Indianapolis IN 46202-5209 |
| Mailing Address |
3715 Kentucky Ave Indianapolis IN 46221-2757 |
| Practice Telephone | 3172740076 |
| Practice Fax Number | 3172740256 |
| Mailing Telephone | 3179464464 |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2020-06-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 12012526A | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | IN DENTAL LICENSE | 12012526A | 01 |
| IN | NPI TYPE 1 | 1578912341 | 01 |
| IN | 201375420 | 05 | |
| IN | CAQH | 13885169 | 01 |
| Street Address |
1130 W MICHIGAN ST FH204 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-5209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679734032 | Corinna Jennifer Yu | Anesthesiology | 1130 W Michigan St, Suite 204, Indianapolis, IN 46202-5209 | 2008-06-18 |
| 1548887714 | Isaac Gerardo Leon-acuna | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2020-07-02 |
| 1851910509 | Sebastian Ruiz | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2020-04-13 |
| 1598227902 | Alyssa M Cooke | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2019-04-03 |
| 1023502317 | Kutaiba Nazif | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2018-06-19 |
| 1588161459 | John David Hoover | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2018-04-09 |
| 1558866269 | Sean Cochran | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Fesler Hall 204, Indianapolis, IN 46202 | 2018-03-26 |
| 1639608102 | Kolin Rubel | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2017-06-08 |
| 1619402401 | Benjamin Michael Wiese | Internal Medicine | 1130 W Michigan St, Indianapolis, IN 46202-5209 | 2017-04-29 |
| 1164956512 | Maham Mahmood | Student in an Organized Health Care Education/Training Program | 1130 W Michigan St, Indianapolis, IN 46202 | 2017-04-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770193591 | Urgent Dental Center Sw LLC | Dentist | 2907 Kentucky Ave Ste A, Indianapolis, IN 46221-2103 | 2020-08-06 |
| 1861027732 | Kendall Thomas Sands | Dentist | 508 Indiana Ave # 3106, Indianapolis, IN 46202-3106 | 2020-03-11 |
| 1184255168 | Know The Drill, LLC | Dentist | 6284 Rucker Road, Suite G, Indianapolis, IN 46220 | 2020-01-29 |
| 1902452055 | Summerlin Dental LLC | Dentist | 3351 N Meridian St Ste 105, Indianapolis, IN 46208-4674 | 2019-08-14 |
| 1255986808 | Ashton Monique Green | Dentist | 9940 Pendleton Pike Ste B, Indianapolis, IN 46236-2823 | 2019-08-09 |
| 1497317309 | Alyssa Marie Hoover | Dentist | 5406 S Emerson Ave, Indianapolis, IN 46237-1970 | 2019-07-01 |
| 1487215455 | Affordable Dentures & Implants - East Indianapolis, P.C. | Dentist | 9749 E Washington St Ste A2, Indianapolis, IN 46229-3035 | 2019-06-21 |
| 1023676178 | Urgent Dental Center South LLC | Dentist | 8925 Madison Ave Ste C, Indianapolis, IN 46227-6257 | 2019-06-04 |
| 1629539697 | Kyle A Harrison | Dentist | 6820 Parkdale Pl Ste 117, Indianapolis, IN 46254-4699 | 2019-03-30 |
| 1659832012 | Renew Dental Arts, LLC | Dentist | 2205 N Delaware St Ste 103, Indianapolis, IN 46205-4363 | 2019-03-28 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46202 |
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| 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.