Healthcare Provider Details

I. General information

NPI: 1376992719
Provider Name (Legal Business Name): MS. XENIA KEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 SIGHTSEEING ROAD BERNHEIM DENTAL CLINIC
FORT BENNING GA
31905
US

IV. Provider business mailing address

2230 CAMILLE DR
COLUMBUS GA
31906-1002
US

V. Phone/Fax

Practice location:
  • Phone: 706-545-2901
  • Fax:
Mailing address:
  • Phone: 706-984-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: