Healthcare Provider Details

I. General information

NPI: 1083344410
Provider Name (Legal Business Name): NATHAN DAVID KECK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 BERKSHIRE PKWY
CLIVE IA
50325-4677
US

IV. Provider business mailing address

1969 S WARRIOR LN
WAUKEE IA
50263-7400
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-7670
  • Fax:
Mailing address:
  • Phone: 515-494-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: