Provider Demographics
NPI:1235148859
Name:SMITH, KEITH SHIPLEY II (DDS MSP)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SHIPLEY
Last Name:SMITH
Suffix:II
Gender:M
Credentials:DDS MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 GULF GATE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-2404
Mailing Address - Country:US
Mailing Address - Phone:941-921-2122
Mailing Address - Fax:941-924-8956
Practice Address - Street 1:3212 GULF GATE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-2404
Practice Address - Country:US
Practice Address - Phone:941-921-2122
Practice Address - Fax:941-924-8956
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics