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General NPI Number Information
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NPI Number | 1164519385
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Entity Type | Organization
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Legal Business Name | KEITH F. THEODORE, DDS
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Dates
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Enumeration Date | 10/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9510 LANHAM SEVERN RD
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City | LANHAM
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State | MD
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Zip | 20706-2624
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Country | US
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Telephone | 301-577-6002
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Fax | 301-577-7267
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Provider Business Mailing Address
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Address Line | 9510 LANHAM SEVERN RD
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City | LANHAM
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State | MD
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Zip | 20706-2624
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Country | US
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Telephone | 301-577-6002
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Fax | 301-577-7267
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH FELIX THEODORE
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Credential | DDS
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Telephone | 301-577-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7399
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License Number State | MD
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