MEDICARE: JEFF S KEH DMD PLLC

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	122300000X	Dentist	30777	TX

General Provider Information

NPI Number	:	1568909778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF S KEH DMD PLLC

Provider Business Mailing Address
First Line	:	23530 KINGSLAND BLVD STE 120
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7466
Country	:	US
Telephone Number	:	281-396-4635
Fax Number	:	832-437-5533

Provider Business Practice Location Address
First Line	:	23530 KINGSLAND BLVD STE 120
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7466
Country	:	US
Telephone Number	:	281-396-4635
Fax Number	:	832-437-5533

Authorized Official
Title or Position	:	OWNER
Name	:	JEFF KEH
Credential	:	DMD
Telephone Number	:	281-396-4635

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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