MEDICARE: DR. SCOTT THOMAS KEYS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4970	LA
2	1223G0001X	General Practice Dentistry	24431	TX
3	1223G0001X	General Practice Dentistry	204434	CO

General Provider Information

NPI Number	:	1255480208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT THOMAS KEYS DDS

Provider Business Mailing Address
First Line	:	2160 AIRLINE DR STE B
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3173
Country	:	US
Telephone Number	:	318-747-5444
Fax Number	:	318-747-6002

Provider Business Practice Location Address
First Line	:	521 COLORADO BLVD
Second Line	:
City	:	IDAHO SPRINGS
State	:	CO
Zip	:	80452-5046
Country	:	US
Telephone Number	:	303-567-4412
Fax Number	:	303-567-4389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	06/07/2023

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