Healthcare Provider Details

I. General information

NPI: 1821024449
Provider Name (Legal Business Name): KEITH ESKANOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 CLEARWATER DR SUITE B
PRESCOTT AZ
86305-7165
US

IV. Provider business mailing address

3103 CLEARWATER DR SUITE B
PRESCOTT AZ
86305-7165
US

V. Phone/Fax

Practice location:
  • Phone: 928-237-6456
  • Fax: 928-777-3209
Mailing address:
  • Phone: 928-237-6456
  • Fax: 928-777-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6419
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: