Provider Demographics
NPI:1164519385
Name:KEITH F. THEODORE, DDS
Entity Type:Organization
Organization Name:KEITH F. THEODORE, DDS
Other - Org Name:(1)LANHAM FAMILY DENTAL CENTER (2)TOOTH-N-NAIL,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:THEODORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-577-6002
Mailing Address - Street 1:9510 LANHAM SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2624
Mailing Address - Country:US
Mailing Address - Phone:301-577-6002
Mailing Address - Fax:301-577-7267
Practice Address - Street 1:9510 LANHAM SEVERN RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2624
Practice Address - Country:US
Practice Address - Phone:301-577-6002
Practice Address - Fax:301-577-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty