Provider Demographics
NPI:1114634086
Name:KEY FAMILY DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:KEY FAMILY DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-770-9174
Mailing Address - Street 1:1099 HELMO AVE. N.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6037
Mailing Address - Country:US
Mailing Address - Phone:651-770-9174
Mailing Address - Fax:651-770-3839
Practice Address - Street 1:1099 HELMO AVE. N.
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6037
Practice Address - Country:US
Practice Address - Phone:651-770-9174
Practice Address - Fax:651-770-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty