Provider Demographics
NPI:1114098795
Name:HULFELD, KEITH G (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:HULFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2307
Mailing Address - Country:US
Mailing Address - Phone:417-358-2013
Mailing Address - Fax:417-358-3755
Practice Address - Street 1:301 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2307
Practice Address - Country:US
Practice Address - Phone:417-358-2013
Practice Address - Fax:417-358-3755
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0131151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice