Provider Demographics
NPI:1275645996
Name:REDD, KEITH REY (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:REY
Last Name:REDD
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 1:930 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337
Mailing Address - Country:US
Mailing Address - Phone:360-377-7621
Mailing Address - Fax:360-377-6465
Practice Address - Street 1:930 PARK AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-377-7621
Practice Address - Fax:360-377-6465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist