Provider Demographics
NPI:1043454341
Name:FABRE, KEITH JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOSEPH
Last Name:FABRE
Suffix:JR
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:P.O. BOX 5958
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6110
Mailing Address - Country:US
Mailing Address - Phone:504-455-5864
Mailing Address - Fax:504-455-5867
Practice Address - Street 1:2665 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-348-4232
Practice Address - Fax:504-348-8094
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5874122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist