Provider Demographics
NPI:1043491012
Name:KEFFER, CHARMAINE ELIZABETH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:ELIZABETH
Last Name:KEFFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:ELIZABETH
Other - Last Name:KEFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2721 RUSTIC BRICK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9642
Mailing Address - Country:US
Mailing Address - Phone:919-329-0472
Mailing Address - Fax:919-772-0537
Practice Address - Street 1:2721 RUSTIC BRICK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9642
Practice Address - Country:US
Practice Address - Phone:919-329-0472
Practice Address - Fax:919-772-0537
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 6954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902249Medicaid