Provider Demographics
NPI:1730178716
Name:ASARKOF, KEITH PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PAUL
Last Name:ASARKOF
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 1:10 MUZZEY ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5222
Mailing Address - Country:US
Mailing Address - Phone:781-862-8330
Mailing Address - Fax:781-863-8565
Practice Address - Street 1:10 MUZZEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5222
Practice Address - Country:US
Practice Address - Phone:781-862-8330
Practice Address - Fax:781-863-8565
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice