Provider Demographics
NPI:1225188675
Name:ALVAREZ, KEITH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:ALVAREZ
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 1:1185 W CARMEL DR
Mailing Address - Street 2:SUITE D2
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8706
Mailing Address - Country:US
Mailing Address - Phone:317-846-1573
Mailing Address - Fax:317-846-1542
Practice Address - Street 1:1185 W CARMEL DR
Practice Address - Street 2:SUITE D2
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8706
Practice Address - Country:US
Practice Address - Phone:317-846-1573
Practice Address - Fax:317-846-1542
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice