Provider Demographics
NPI:1003026857
Name:LEVER, KEITH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:LEVER
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 1:7321 S STATE ST
Mailing Address - Street 2:STE #C
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2055
Mailing Address - Country:US
Mailing Address - Phone:801-255-2514
Mailing Address - Fax:801-255-3040
Practice Address - Street 1:7321 S STATE ST
Practice Address - Street 2:STE #C
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2055
Practice Address - Country:US
Practice Address - Phone:801-255-2514
Practice Address - Fax:801-255-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT470531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice