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General NPI Number Information
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NPI Number | 1700174299
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Entity Type | Individual
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Provider Name | KEITH BRIAN DOUTS JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 6920 INDIANAPOLIS BLVD
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City | HAMMOND
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State | IN
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Zip | 46324-2206
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Country | US
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Telephone | 219-763-8112
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Fax | 219-844-9006
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | PORTAGE
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State | IN
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Zip | 46368-9230
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Country | US
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Telephone | 219-763-8112
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Fax | 219-764-3251
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011663A
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License Number State | IN
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