Healthcare Provider Details

I. General information

NPI: 1285761742
Provider Name (Legal Business Name): KEITH TYLER SOLIDAY DDS (ORAL SURGEON)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BUFORD AVE
GETTYSBURG PA
17325
US

IV. Provider business mailing address

228 BUFORD AVE
GETTYSBURG PA
17325
US

V. Phone/Fax

Practice location:
  • Phone: 717-337-9377
  • Fax: 717-337-3883
Mailing address:
  • Phone: 717-337-9377
  • Fax: 717-337-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS028948L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: