Provider Demographics
NPI:1134700883
Name:NGUYEN, KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:NGUYEN
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 1:204 TUTTLE CREEK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6606
Mailing Address - Country:US
Mailing Address - Phone:785-560-6078
Mailing Address - Fax:
Practice Address - Street 1:204 TUTTLE CREEK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6606
Practice Address - Country:US
Practice Address - Phone:785-560-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371491223G0001X
KS621961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice