Provider Demographics
NPI:1003922956
Name:SERXNER, KEITH EVAN (DDS,MSPH)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EVAN
Last Name:SERXNER
Suffix:
Gender:M
Credentials:DDS,MSPH
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3438
Mailing Address - Country:US
Mailing Address - Phone:818-790-1160
Mailing Address - Fax:818-790-5603
Practice Address - Street 1:747 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3438
Practice Address - Country:US
Practice Address - Phone:818-790-1160
Practice Address - Fax:818-790-5603
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31704OtherLICENSE