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General NPI Number Information
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NPI Number | 1639247588
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Entity Type | Organization
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Legal Business Name | KEITH D JAMESON DDS PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4041 CERRILLOS RD
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City | SANTE FE
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State | NM
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Zip | 87507-2916
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Country | US
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Telephone | 505-438-3276
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Fax | 505-474-8201
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Provider Business Mailing Address
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Address Line | 4041 CERRILLOS RD
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City | SANTE FE
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State | NM
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Zip | 87507-2916
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Country | US
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Telephone | 505-438-3276
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Fax | 505-474-8201
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Authorized Official
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Title or Position | OWNER
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Name | KEITH D JAMESON
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Credential | DDS
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Telephone | 505-438-3276
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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 | 1408
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License Number State | NM
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