MEDICARE: DR. SHANDRA LADREA KEITH D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	4522	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265532733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANDRA LADREA KEITH D.M.D

Provider Business Mailing Address
First Line	:	2305 ARLINGTON AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205
Country	:	US
Telephone Number	:	205-930-0705
Fax Number	:	205-930-0809

Provider Business Practice Location Address
First Line	:	2305 ARLINGTON AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205
Country	:	US
Telephone Number	:	205-930-0705
Fax Number	:	205-930-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. SHANDRA LADREA KEITH D.M.D” Practice Location

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