Provider Demographics
NPI:1194842989
Name:KEITH, SCOTT WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:KEITH
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 1:9780 E SAN SALVADOR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5621
Mailing Address - Country:US
Mailing Address - Phone:480-391-0712
Mailing Address - Fax:480-391-3598
Practice Address - Street 1:740 E HIGHLAND AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3649
Practice Address - Country:US
Practice Address - Phone:602-264-0707
Practice Address - Fax:602-266-8102
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice