Healthcare Provider Details

I. General information

NPI: 1043491012
Provider Name (Legal Business Name): CHARMAINE ELIZABETH KEFFER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARMAINE ELIZABETH KEFFER DDS

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 RUSTIC BRICK RD
RALEIGH NC
27603-9642
US

IV. Provider business mailing address

2721 RUSTIC BRICK RD
RALEIGH NC
27603-9642
US

V. Phone/Fax

Practice location:
  • Phone: 919-329-0472
  • Fax: 919-772-0537
Mailing address:
  • Phone: 919-329-0472
  • Fax: 919-772-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberNC 6954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: