Provider Demographics
NPI:1245773233
Name:DANIEL J. KEITH, DDS, MS, PC
Entity Type:Organization
Organization Name:DANIEL J. KEITH, DDS, MS, PC
Other - Org Name:DK ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTISTS - BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:701-751-8444
Mailing Address - Street 1:4401 COLEMAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1370
Mailing Address - Country:US
Mailing Address - Phone:701-751-8444
Mailing Address - Fax:
Practice Address - Street 1:4401 COLEMAN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1370
Practice Address - Country:US
Practice Address - Phone:701-751-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1464024Medicaid