Provider Demographics
NPI:1083306328
Name:SACRY, KEATON (DMD)
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:
Last Name:SACRY
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 1:9281 SILVER ARROW CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6413
Mailing Address - Country:US
Mailing Address - Phone:406-498-2235
Mailing Address - Fax:
Practice Address - Street 1:10530 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3050
Practice Address - Country:US
Practice Address - Phone:702-802-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program