Healthcare Provider Details

I. General information

NPI: 1306482104
Provider Name (Legal Business Name): KEITH R.R. GAUGHT, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 SIX FORKS RD STE 110
RALEIGH NC
27615-5072
US

IV. Provider business mailing address

7718 SIX FORKS RD STE 110
RALEIGH NC
27615-5072
US

V. Phone/Fax

Practice location:
  • Phone: 919-847-6453
  • Fax:
Mailing address:
  • Phone: 919-847-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH RICHARD REUBEN GAUGHT
Title or Position: PRESIDENT
Credential: DDS
Phone: 919-847-6453