Healthcare Provider Details

I. General information

NPI: 1528488947
Provider Name (Legal Business Name): STEVEN J. KEISER DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 N TUSTIN ST SUITE 104
ORANGE CA
92867-7780
US

IV. Provider business mailing address

172 N TUSTIN ST SUITE 104
ORANGE CA
92867-7780
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-1178
  • Fax:
Mailing address:
  • Phone: 714-538-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: STEVE J. KEISER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 714-538-1178