Provider Demographics
NPI:1083132252
Name:KEITH, AMBER (PHDHP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-8120
Mailing Address - Country:US
Mailing Address - Phone:814-932-5560
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE STE D103
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4814
Practice Address - Country:US
Practice Address - Phone:814-889-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PHDH000078124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist