Provider Demographics
NPI:1073772687
Name:KEETON, DAVID L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:KEETON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9234 N LOOP 1604 W STE 121
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2984
Mailing Address - Country:US
Mailing Address - Phone:210-681-1121
Mailing Address - Fax:
Practice Address - Street 1:9234 N LOOP 1604 W STE 121
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2984
Practice Address - Country:US
Practice Address - Phone:210-681-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401413167122300000X
KY8605122300000X
TX252401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist