Provider Demographics
NPI:1083702153
Name:KEY, GARY STEPHEN (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:KEY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 E 70TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4701
Mailing Address - Country:US
Mailing Address - Phone:318-797-0643
Mailing Address - Fax:
Practice Address - Street 1:2433 E 70TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4701
Practice Address - Country:US
Practice Address - Phone:318-797-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1829919Medicare ID - Type UnspecifiedDENTIST