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General NPI Number Information
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NPI Number | 1205822681
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Entity Type | Individual
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Provider Name | KEIFER LAYNE FISHER DDS
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 318 W BROADWAY ST
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City | SPIRO
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State | OK
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Zip | 74959-2422
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Country | US
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Telephone | 918-962-2466
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Fax | 918-962-4004
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Provider Business Mailing Address
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Address Line | 318 W BROADWAY ST
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City | SPIRO
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State | OK
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Zip | 74959-2422
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Country | US
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Telephone | 918-962-2466
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Fax | 918-962-4004
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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 | 4826
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License Number State | OK
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