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General NPI Number Information
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NPI Number | 1558401505
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Entity Type | Individual
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Provider Name | KEITH ALAN CHURCHILL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 615 16TH ST SW
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City | ROCHESTER
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State | MN
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Zip | 55902-2123
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Country | US
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Telephone | 507-288-2539
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Fax | 507-288-9230
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Provider Business Mailing Address
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Address Line | 6530 31ST AVE SW
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City | ROCHESTER
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State | MN
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Zip | 55902-2429
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Country | US
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Telephone | 507-288-1784
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Fax |
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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 | 6951D
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License Number State | MN
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