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General NPI Number Information
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NPI Number | 1154847622
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Entity Type | Organization
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Legal Business Name | ALEX KEITH, DMD, DENTAL CORPORATION
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4330 GOLDEN CENTER DR STE A
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City | PLACERVILLE
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State | CA
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Zip | 95667-6232
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Country | US
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Telephone | 530-642-8614
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Fax | 530-642-9314
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Provider Business Mailing Address
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Address Line | 4330 GOLDEN CENTER DR STE A
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City | PLACERVILLE
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State | CA
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Zip | 95667-6232
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Country | US
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Telephone | 530-642-8614
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Fax | 530-642-9314
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEX KEITH
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Credential | DMD
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Telephone | 510-912-0923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 100100
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License Number State | CA
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