Provider Demographics
NPI:1760210306
Name:SERRANO, KEITH GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:GEORGE
Last Name:SERRANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 N 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-3477
Mailing Address - Country:US
Mailing Address - Phone:602-400-9895
Mailing Address - Fax:
Practice Address - Street 1:2755 S 99TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1404
Practice Address - Country:US
Practice Address - Phone:623-478-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0122851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice