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General NPI Number Information
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NPI Number | 1306482104
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Entity Type | Organization
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Legal Business Name | KEITH R.R. GAUGHT, DDS, PA
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 7718 SIX FORKS ROAD SUITE 110
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City | RALEIGH
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State | NC
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Zip | 27615-5072
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Country | US
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Telephone | 919-847-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HEDWIG CT
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City | CARY
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State | NC
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Zip | 27518-8693
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Country | US
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Telephone | 219-916-6119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH RICHARD REUBEN GAUGHT
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Credential | DDS
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Telephone | 919-847-6453
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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