Provider Demographics
NPI:1548375942
Name:KEITH, CHARLES JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
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 1:315 SARALAND BLVD N
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2101
Mailing Address - Country:US
Mailing Address - Phone:251-675-8658
Mailing Address - Fax:
Practice Address - Street 1:315 SARALAND BLVD N
Practice Address - Street 2:SUITE C
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2101
Practice Address - Country:US
Practice Address - Phone:251-675-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice