Provider Demographics
NPI:1114146453
Name:KEATHLEY, CESAR JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:JAMES
Last Name:KEATHLEY
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 1:130 CARLYLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1805
Mailing Address - Country:US
Mailing Address - Phone:727-787-6478
Mailing Address - Fax:
Practice Address - Street 1:27001 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 8520
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3402
Practice Address - Country:US
Practice Address - Phone:727-799-0650
Practice Address - Fax:727-797-9273
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN81981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery