MEDICARE: DR. JOSIE SY KEAT DDS

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	1223D0001X	Public Health Dentistry	0401005912	VA

General Provider Information

NPI Number	:	1477661585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSIE SY KEAT DDS

Provider Business Mailing Address
First Line	:	2579 JOHN MILTON DR
Second Line	:	#250
City	:	OAK HILL
State	:	VA
Zip	:	20171-2563
Country	:	US
Telephone Number	:	703-860-8860
Fax Number	:	703-860-8861

Provider Business Practice Location Address
First Line	:	2579 JOHN MILTON DR
Second Line	:	#250
City	:	OAK HILL
State	:	VA
Zip	:	20171-2563
Country	:	US
Telephone Number	:	703-860-8860
Fax Number	:	703-860-8861

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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