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General NPI Number Information
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NPI Number | 1588683171
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Entity Type | Individual
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Provider Name | JENNIFER DARLENE KEYSER DDS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 600 LANIER AVE W STE 201
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1833
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Country | US
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Telephone | 770-692-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 600 LANIER AVE W STE 201
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1833
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Country | US
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Telephone | 770-692-0453
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS035140
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN015345
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License Number State | GA
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