Healthcare Provider Details

I. General information

NPI: 1912985912
Provider Name (Legal Business Name): KAREN MARIE KEITH DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL DENTAL ACTIVITY CMR 402
APO AE
09180
US

IV. Provider business mailing address

2352 MEADOWS BLVD STE 205
CASTLE ROCK CO
80109-8408
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-4130
  • Fax:
Mailing address:
  • Phone: 303-663-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204170
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN.00204170
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number11-K5378
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019022459
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019022459
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: