Provider Demographics
NPI:1861066649
Name:KEYSDENTALCO., PLLC IS
Entity type:Organization
Organization Name:KEYSDENTALCO., PLLC IS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-567-4412
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-1534
Mailing Address - Country:US
Mailing Address - Phone:303-567-4412
Mailing Address - Fax:
Practice Address - Street 1:1625 MINER ST
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452-5097
Practice Address - Country:US
Practice Address - Phone:303-567-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSDENTALCO., PLLC IS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental