Healthcare Provider Details

I. General information

NPI: 1043728827
Provider Name (Legal Business Name): LANCE D KEYES DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32650 STATE ROUTE 20 STE E106
OAK HARBOR WA
98277
US

IV. Provider business mailing address

32650 STATE ROUTE 20 STE E106
OAK HARBOR WA
98277-2641
US

V. Phone/Fax

Practice location:
  • Phone: 360-240-9400
  • Fax: 360-675-5754
Mailing address:
  • Phone: 360-240-9400
  • Fax: 360-675-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60651466
License Number StateWA

VIII. Authorized Official

Name: KAYLLA RUSSELL
Title or Position: ADMIN ASSISTANT
Credential:
Phone: 360-672-4168