Healthcare Provider Details

I. General information

NPI: 1285815589
Provider Name (Legal Business Name): GARY DEMETRICK KEELER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 HUNTERS CROSSING DR.
ALCOA TN
37701
US

IV. Provider business mailing address

1060 E COUNTY LINE RD STE 3A-213
RIDGELAND MS
39157-1900
US

V. Phone/Fax

Practice location:
  • Phone: 865-223-6705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8114
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.028230
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3478
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: