Provider Demographics
NPI:1144688672
Name:KEITH, ALEXANDER (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 GOLDEN CENTER DR
Mailing Address - Street 2:#A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6232
Mailing Address - Country:US
Mailing Address - Phone:510-912-0923
Mailing Address - Fax:
Practice Address - Street 1:4330 GOLDEN CENTER DR
Practice Address - Street 2:#A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6232
Practice Address - Country:US
Practice Address - Phone:510-912-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist