Provider Demographics
NPI:1275605487
Name:ACHESON, KEITH RAYMON (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:RAYMON
Last Name:ACHESON
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 1:309 W LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:512-331-7000
Mailing Address - Fax:512-238-1312
Practice Address - Street 1:309 W LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:512-331-7000
Practice Address - Fax:512-238-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice