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General NPI Number Information
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NPI Number | 1194803072
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Entity Type | Individual
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Provider Name | MATTHEW AARON KEIM DDS PC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 124 N MAIN
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City | MIAMI
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State | OK
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Zip | 74354
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Country | US
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Telephone | 918-542-1639
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Fax | 918-540-9141
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Provider Business Mailing Address
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Address Line | 2124 G SW
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City | MIAMI
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State | OK
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Zip | 74354
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Country | US
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Telephone | 918-542-8389
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Fax | 918-540-9141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 85697
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License Number State | OK
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