Provider Demographics
NPI:1275011165
Name:KEITH, ANDREW JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACOB
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 1:2607 WESTERN AVE APT 153
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1334
Mailing Address - Country:US
Mailing Address - Phone:425-466-8544
Mailing Address - Fax:
Practice Address - Street 1:1416 HIGHLANDS DR NE STE 120
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6240
Practice Address - Country:US
Practice Address - Phone:425-557-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608644531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice