Provider Demographics
NPI:1083300222
Name:KEYSTONE DENTAL CARE, INC
Entity Type:Organization
Organization Name:KEYSTONE DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:BEGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:423-461-0798
Mailing Address - Street 1:603 BERT ST STE 206
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5872
Mailing Address - Country:US
Mailing Address - Phone:423-232-7919
Mailing Address - Fax:
Practice Address - Street 1:603 BERT ST STE 206
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5872
Practice Address - Country:US
Practice Address - Phone:423-232-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty