Provider Demographics
NPI:1538987748
Name:DR. KEEPER'S DENTAL WELLNESS
Entity type:Organization
Organization Name:DR. KEEPER'S DENTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:415-906-2069
Mailing Address - Street 1:450 SUTTER ST RM 2522
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4208
Mailing Address - Country:US
Mailing Address - Phone:415-906-2069
Mailing Address - Fax:415-390-3130
Practice Address - Street 1:450 SUTTER ST RM 2522
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4208
Practice Address - Country:US
Practice Address - Phone:415-906-2069
Practice Address - Fax:415-390-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902048119Medicaid