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General NPI Number Information
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NPI Number | 1457375776
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Entity Type | Organization
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Legal Business Name | R KEITH DEDMOND DDS PA
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 S ACADEMY STREET
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City | LINCOLNTON
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State | NC
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Zip | 28092
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Country | US
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Telephone | 704-735-7001
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Fax | 704-735-7654
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Provider Business Mailing Address
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Address Line | 301 S ACADEMY STREET
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City | LINCOLNTON
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State | NC
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Zip | 28092
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Country | US
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Telephone | 704-735-7001
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Fax | 704-735-7654
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Authorized Official
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Title or Position | DENTIST
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Name | R KEITH DEDMOND
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Credential | DDS PA
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Telephone | 704-735-7001
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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 | 4049
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License Number State | NC
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